title: New method for sternal closure after vacuum-assisted therapy in deep sternal infections after cardiac surgery.
abstract: The treatment of nonhealing and infected sternotomies after cardiac surgery is a challenging task with increased rates of mortality and morbidity, as well as high costs. A local vacuum therapy (ie, the vacuum-assisted closure system) permits the treatment of deep sternal infections due to continuous aspiration and a sealed dressing that stimulates granulation tissue formation. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep wound infection enhances sternal preservation and the speed of potential rewiring. After some weeks of vacuum-assisted closure therapy, a complete preparation of the substernal structures is necessary. In this context, laceration of the right ventricle is a rare but life-threatening complication. We describe a new technique for sternal closure after vacuum-assisted wound treatment using Nitinol clips (Praesidia, Bologna, Italy), which can prevent these severe complications. Without any preparation of the substernal tissue the clips can be inserted in the parasternal space with consecutive proper stabilization of the sternum. This new method represents an easy, low-cost and complication-free procedure.
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany. nreiss@gmx.de <nreiss@gmx.de>
authors.forename: Nils
authors.initials: N
authors.lastname: Reiss
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schuett
authors.forename: Michael
authors.initials: M
authors.lastname: Kemper
authors.forename: Andreas
authors.initials: A
authors.lastname: Bairaktaris
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009779:Occlusive Dressings; D013249:Sternum / Q000601:surgery*; D013396:Suction; D013525:Surgical Instruments; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation*; D014618:Vacuum