Vacuum-assisted closure as a treatment modality for infections after cardiac surgery.
OBJECTIVE
Wound infections after cardiac surgery carry high morbidity and mortality. A plethora of management strategies have been used to treat such infections. We assessed the impact of vacuum-assisted closure on the management of sternal wound infections in terms of wound healing, duration of vacuum-assisted closure, and cost of treatment.


METHODS
Between November 1998 and June 2001, a total of 27 mediastinal infections were managed with vacuum-assisted closure. Group A (n = 14) had vacuum-assisted closure as the final treatment modality, whereas in group B (n = 13) vacuum-assisted closure was followed by either a myocutaneous flap (n = 8) or primary (n = 5) wound closure. The choice of additional treatment modality was based on wound size.


RESULTS
In group A, 4 patients died and a satisfactorily healed scar was achieved in 64% of cases. Median durations of vacuum-assisted closure and hospital stay in group A were 13.5 days (interquartile range 8.8-32.2 days) and 20 days (interquartile range 16.7-25.2 days), respectively. Mortality was 7.7% in group B, with a treatment failure rate of 15%. Median duration of vacuum-assisted closure in group B was 8 days (interquartile range 5.5-18 days), and median hospital stay was 29 days (interquartile range 25.8-38.2 days). During the year before institution of vacuum-assisted closure, poststernotomy infection (n = 13) was managed with rewiring and closed irrigation system. Treatment during this year failed in 30.7% of cases (n = 4/13), and mortality was also 30.7%. The total cost (hospitalization and treatment) per patient for vacuum-assisted closure was 16,400 dollars, compared with 20,000 dollars for the closed irrigation system treatment.


CONCLUSIONS
Vacuum-assisted closure, used alone or before other surgical treatment strategies, is an acceptable treatment modality for infections in cardiac surgery with reasonable morbidity, mortality, and cost.
Luckraz
Heyman
H
Cardiothoracic Surgical Unit, Papworth Hospital, Papworth, Everard, Cambridge, United Kingdom. HeymanLuckraz@aol.com
Murphy
Fiona
F
Bryant
Steve
S
Charman
Susan C
SC
Ritchie
Andrew J
AJ
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016106:Methicillin Resistance; D008875:Middle Aged; D009017:Morbidity; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D013203:Staphylococcal Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013211:Staphylococcus aureus; D013396:Suction / Q000191:economics / Q000379:methods*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000191:economics / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents