title: In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy?
abstract: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether vacuum-assisted closure therapy (VAC) is superior to conventional therapy for treating post-sternotomy mediastinitis. Altogether >261 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several studies indicate that VAC therapy is associated with shorter lengths of intensive care and in-hospital stay as well as faster rates of wound healing and fewer dressing changes. It has also been shown that VAC therapy is correlated with a statistically significant reduction in reinfection rates, particularly those that occur in the early postoperative period (at the 1-week follow-up). Patients can be discharged with the dressing in situ and managed in the community with a view to delayed closure or reconstruction. However, the studies comparing VAC with conventional therapy are all retrospective in nature and reinforce the need for randomized controlled trials in order to more accurately establish differences in outcomes between VAC and conventional therapy. Additionally, owing tło the variability of treatment protocols within the non-VAC arm, it is more challenging to draw definitive conclusions regarding the superiority of VAC therapy to every modality that is considered conventional treatment. We conclude that VAC therapy is a portable and an increasingly economical option for the treatment of post sternotomy mediastinitis. Although reductions in mortality rates were not reproduced in all studies, evidence suggests that VAC should still be considered as a first-line therapy for post-sternotomy mediastinitis and as a bridge therapy to musculocutaneous reconstruction or primary closure.
authors.affiliation: Royal Free and University College Medical School, University College, London, UK.
authors.forename: Angela W
authors.initials: AW
authors.lastname: Yu
authors.forename: Radoslaw A
authors.initials: RA
authors.lastname: Rippel
authors.forename: Elliott
authors.initials: E
authors.lastname: Smock
authors.forename: Omar A
authors.initials: OA
authors.lastname: Jarral
mesh_terms: D019985:Benchmarking; D019317:Evidence-Based Medicine; D006801:Humans; D007902:Length of Stay; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Cardiac surgical procedures; Deep sternal wound infection; Negative pressure wound therapy; Vacuum-assisted closure therapy
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