Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis.
OBJECTIVE
Poststernotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery that continues to have a significant morbidity and mortality despite aggressive therapy. Vacuum-assisted closure uses controlled suction to provide evacuation of wound fluid, decrease bacterial colonization, stimulate granulation tissue, and reduce the need for dressing changes.


METHODS
One hundred two patients from Duke University Hospital, The Durham Veterans Administration Hospital, and referring institutions underwent vacuum-assisted closure treatment. There were 63 men and 39 women, with a mean age of 67. The infection was noticed between postoperative days 8 and 34, at which time the wounds were opened and debrided.


RESULTS
Ninety-six of the 102 patients received vacuum-assisted therapy while the remaining 6 underwent daily multiple dressing changes without vacuum-assisted therapy. Fifty-three of the 96 patients required only sternal debridement, followed by wound vacuum therapy and closure by secondary intention, while the remaining 43 had an additional procedure. Of these, 33 patients underwent omental transposition and 10 patients had a pectoralis flap. The length of stay for all patients was 27 +/- 12 days. This was related in part to intravenous antibiotics. Hospital mortality for all patients was 3.7% (4 patients). Two of these patients underwent vascular flap and succumbed to multisystemic organ failure, while the other 2 received only wound vacuum therapy following debridement and succumbed to overwhelming sepsis.


CONCLUSIONS
Vacuum-assisted drainage is an effective therapy for mediastinitis following debridement or before placement of a vascularized tissue flap.
Domkowski
Patrick W
PW
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Smith
Monica L
ML
Gonyon
Denis L
DL
Drye
Carol
C
Wooten
Mary Kay
MK
Levin
L Scott
LS
Wolfe
Walter G
WG
D000368:Aged; D001458:Bandages; D006348:Cardiac Surgical Procedures; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000628:therapy*; D009657:North Carolina; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D014618:Vacuum