title: Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery.
abstract: BACKGROUND
  Sternal wound infections are a serious complication arising from cardiac surgery. Recently, the general application of negative pressure to wounds by vacuum-assisted closure (VAC) therapy has shown enhanced granulation and wound contraction. Here we examine the effect of VAC on sternal wounds.
  
  
  METHODS
  We collected and statistically analyzed quantitative VAC performance data and outcomes with a retrospective review on a consecutive cohort of 22 patients treated with VAC for post-cardiac surgery wound complications.
  
  
  RESULTS
  Sternal wound infections became evident on average at 21.0 days after surgery, associated with dehiscence (82%), sternal instability (59%), fluid collection by computed tomography (73%), and osteomyelitis (41%). Cultures most commonly identified Staphylococcus aureus (50%). Prompt irrigation and debridement were performed on all patients, and VAC therapy was applied at approximately 7.3 days after diagnosis. Vacuum-assisted closure induced granulation of 71% of the sternal wound area by 7 days, with a daily drainage of approximately 84 mL. By 14 days, there was a 54% reduction in wound size, and patients were discharged after approximately 19.5 days and placed on home therapy. Vacuum-assisted closure was discontinued at approximately 36.7 days with an average reduction in sternal wound size of 80%. Extensive secondary surgical closure, requiring muscle flaps, was avoided in 64% of patients, whereas 28% of patients required no surgical reconstruction for wound closure. No complications were related to VAC use.
  
  
  CONCLUSIONS
  In contrast to our earlier studies, adjunctive VAC therapy markedly reduced required surgical interventions, reoperation for persistent infections, and the hospitalization period. Thus, VAC provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after medial sternotomy.
authors.affiliation: Division of Plastic Surgery, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kyle Northcote
authors.initials: KN
authors.lastname: Cowan
authors.forename: Laura
authors.initials: L
authors.lastname: Teague
authors.forename: Sammy C
authors.initials: SC
authors.lastname: Sue
authors.forename: James L
authors.initials: JL
authors.lastname: Mahoney
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D014618:Vacuum