The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery.
BACKGROUND
The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation.


METHODS
Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement.


RESULTS
Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%.


CONCLUSIONS
The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery.
Fleck
Tatjana M
TM
Department of Cardiothoracic Surgery, University of Vienna, Austria. t9204604@hotmail.com
Fleck
Michael
M
Moidl
Reinhard
R
Czerny
Martin
M
Koller
Rupert
R
Giovanoli
Pietro
P
Hiesmayer
Michael J
MJ
Zimpfer
Daniel
D
Wolner
Ernst
E
Grabenwoger
Martin
M
D000368:Aged; D001026:Coronary Artery Bypass; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000295:instrumentation; D013249:Sternum / Q000601:surgery*; D013396:Suction / Q000295:instrumentation*; D013530:Surgical Wound Infection / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D014945:Wound Healing / Q000502:physiology