Vacuum-Assisted Closure in the Treatment of Sternal Wound Infection After Cardiac Surgery

Abstract

Aim: Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies.Methods: From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superfi cial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m 2 (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %).Results: Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to defi nite wound closure. Three patients (9 %) with chronic fi stula were re-admitted 1 to 6 months after VAC therapy.Conclusions: VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an eff ective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.

Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery

“…Since the first use of the VAC device by Argenta and Morykwas in the 1990s, this therapy has rapidly evolved into a widely accepted modality for the treatment of SSI following cardiovascular surgery [1][2][3][4][7][8][9]. As a treatment, VAC therapy holds several major advantages.…”

“…Furthermore, the condition of the wound can be observed at the time of changing the VAC dressing. The second benefit is that VAC therapy can aid wound healing [1][2][3][4]. The controlled local application of negative pressure to the wound approximates the edges of the wound and provides a mass filling effect.…”

“…The application of continuous negative pressure to the wound provides a stronger fixation of the subcutaneous tissue and the bones of the sternum and ribs. This can lead to pain reduction, and it enables the patient to mobilize and breathe spontaneously through weaning from artificial ventilation [1,2]. In addition, the invention of the portable devices helps patients to actively mobilize.…”

“…Vacuum-assisted closure (VAC) therapy has been widely accepted as a treatment modality for SSI following cardiovascular procedures. One of the most important advantages of VAC therapy is that it may be able to accelerate wound healing by continuous negative pressure [1,2]. In addition, VAC therapy may be a feasible option for the treatment of graft or device-related infections following cardiovascular operations [5,14,15].…”

“…Surgical site infection (SSI) following cardiovascular surgery is reported to occur in 1-10 % of cases [1][2][3][4] and can result in prolonged hospitalization and a higher mortality rate (9.8-14 %) [4]. Vacuum-assisted closure (VAC) therapy has been widely accepted as a treatment modality for SSI following cardiovascular procedures.…”