title: Negative pressure therapy for post-sternotomy wound infections in young children.
abstract: OBJECTIVE
  Post-sternotomy wound infection remains a significant morbidity in congenital and paediatric cardiac surgery. However, the techniques used for this complication in children are not optimal in terms of mortality, morbidity and the use of medical resources. Negative pressure therapy is an effective modality in the treatment in adults, but reports of its use in children are limited. This study evaluated the use of negative pressure therapy in young children for post-sternotomy wound infections.
  
  
  METHODS
  From October 2004 to June 2012, 15 consecutive cases of post-sternotomy wound infections in patients ≤6 years of age were managed with negative pressure therapy, and these patients were followed up for ≥12 months after wound closure. The median Aristotle comprehensive complexity score was 9.9 ± 4.0. The infection was identified at a median of 16 days after surgery, and the procedure was performed within 24 h of diagnosis. No additional surgical procedures were applied.
  
  
  RESULTS
  No cases of hospital mortality or second surgery for infection control occurred. The median duration until wound closure was 25 days (range: 5-92 days). Further, no patient showed sternal instability at treatment termination. During the mean follow-up period of 45.8 ± 31.3 months after wound closure, no admission occurred for infection recurrence. According to a multivariable analysis, the infection depth and patient weight significantly lengthened treatment duration (P = 0.008 and 0.046, respectively).
  
  
  CONCLUSIONS
  Negative pressure therapy is an effective treatment modality for wound infections in paediatric cardiac surgery and results in low morbidity, mortality and medical resource use.
authors.affiliation: Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawajiri
authors.affiliation: Division of Cardiovascular Surgery, Keio University, Tokyo, Japan aebajp@gmail.com.
authors.forename: Ryo
authors.initials: R
authors.lastname: Aeba
authors.affiliation: Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Takaki
authors.affiliation: Division of Cardiovascular Surgery, Keio University, Tokyo, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yozu
authors.affiliation: Center for Infectious Diseases and Infection Control, Keio University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Congenital heart disease; Sternotomy; Wound infection