Sternal osteomyelitis: use of vacuum-assisted closure device as an adjunct to definitive closure with sternectomy and muscle flap reconstruction.
OBJECTIVE
Sternal osteomyelitis following cardiac surgery often requires debridement and flap coverage. The VAC (vacuum-assisted closure) device has been useful in complex wound coverage. A retrospective review of a single surgeon's experience with sternal reconstruction using the VAC device as an adjunct to debridement and muscle flap reconstruction was performed.


METHODS
Thirteen consecutive patients over a 34-month period underwent debridement and reconstruction of sternal wounds. Eleven patients (85%) were males, and two (15%) were females. Mean age was 61 years (range: 43-73 years). Acute purulent sternal infections occurred in seven patients, while chronic sternal osteomyelitis was seen in six patients. Use of the VAC device during the perioperative period was evaluated.


RESULTS
Of the 13 patients, the VAC device was used prior to flap closure in six patients, and after flap closure in two patients. Sternal debridement with bilateral pectoralis muscle flaps was used to reconstruct 12 patients, and one patient underwent debridement only with VAC placement. All 13 patients (100%) had complete closure of their complex wounds at an average of follow-up of 14 months.


CONCLUSIONS
The VAC device is useful in the treatment of sternal osteomyelitis in three contexts: (1) as a temporary wound care technique preoperatively that minimizes dressing changes and prevents shear stresses of an open sternum, (2) as the sole method of wound closure in specific cases, and (3) as a technique to facilitate healing in postoperative flap reconstruction cases complicated by reinfection.
Scholl
Lynette
L
Division of Plastic and Reconstructive Surgery, Department of Surgery and the Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California 94305, USA.
Chang
Eric
E
Reitz
Bruce
B
Chang
James
J
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004864:Equipment and Supplies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D010369:Pectoralis Muscles / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014618:Vacuum; D014945:Wound Healing