Vacuum-assisted wound closure is superior to primary rewiring in patients with deep sternal wound infection.
OBJECTIVE
Deep sternal wound infections are serious complications after cardiac surgery. The aim of the present study is to compare the outcome after vacuum-assisted wound closure to that after primary rewiring with disinfectant irrigation. The study additionally focuses on defining predictors for the failure of primary rewiring and its impact on postoperative outcome.


METHODS
Retrospective analysis was performed in 5232 patients who underwent cardiac surgery with a median sternotomy. 192 patients postoperatively developed deep sternal wound infections and were distributed into 2 therapy groups: a vacuum-assisted wound closure (= VAC) group and a primary rewiring (= RW) group, which was subdivided into healing after rewiring (= RW-h) and failure of rewiring (= RW-f). These groups were compared statistically to reveal coincidental pre-, intra- and postoperative parameters.


RESULTS
Compared to the VAC group, the RW group showed a poorer outcome, although RW baseline characteristics were apparently beneficial. Primary rewiring failed in 45.8 % of all cases, which led to even worse outcomes. Important predictors for failure of primary rewiring were morbid obesity, diabetes mellitus type II, chronic obstructive pulmonary disease, preoperatively impaired left ventricular function, postoperatively positive blood and wound cultures, bilateral harvesting of internal thoracic arteries and the need for surgical reexploration.


CONCLUSIONS
In spite of patients being in a worse condition, vacuum-assisted wound closure therapy resulted in improved outcomes and thus should be preferred to primary rewiring. Moreover we report on predictors which may indicate whether there is a high risk of rewiring failure.
Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
A
A
Assmann
U
U
Boeken
P
P
Feindt
P
P
Schurr
P
P
Akhyari
A
A
Lichtenberg
D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D007902:Length of Stay; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing
D000891:Anti-Infective Agents, Local