title: Treatment of sternal wound infection with vacuum-assisted closure.
abstract: BACKGROUND
  Previous work has demonstrated the efficacy of vacuum-assisted closure (VAC) in the treatment of poststernotomy local wound infections, compared to historical treatment protocol. The negative pressure has been found to protect wounds against contamination, prevent wound fluid retention, increase blood flow, and increase rates of granulation tissue formation. For this study, a retrospective analysis compared patients receiving VAC as definitive treatment versus bridging to delayed flap closure.
  
  
  METHODS
  Sixteen patients developed sternal wound infections after cardiac surgeries at the authors' institution from 2006 to 2008. Data was gathered regarding patient comorbidities, treatment method, and outcome. Study objectives included assessment of risk factors that warranted secondary surgicalclosure and examination of long-term followup where VAC was thedefinitive treatment modality.
  
  
  RESULTS
  Group A (n = 12) had VAC as the final treatment modality. Group B (n = 4) required myocutaneous flap closure. One patient in Group B passed away prior to flap surgery. Both groups had similar risk factors, except Group B had a higher risk of body mass index (BMI) > 35 that was near statistically significant (P = 0.085; odds ratio = 0.0, 95% CI = [0.0 - 1.21]). Group A required a shorter hospital stay on average. Long-term follow-up showed the majority of Group A had completely healed sternal wounds 2-3 years from initial cardiac surgery.
  
  
  CONCLUSIONS
  Vacuum-assisted closure as definitive treatment modality is a successful, first line therapy for local superficial sternal wound infections. When deep infections occur, however, VAC as bridge-to-flap coverage is recommended over attempted secondary healing with VAC. ﻿.
authors: Department of Orthopaedic Surgery, University of Arizona Medical Center, Tucson, Arizona; email: dezfuli@email.arizona.edu.
authors: Bobby
authors: B
authors: Dezfuli
authors: Department of Public Health Sciences Division of Biostatistics, University of California (UC) Davis, Davis, CA.
authors: Chin-Shang
authors: CS
authors: Li
authors: Department of Surgery, Division of Cardiothoracic Surgery, UC Davis School of Medicine, Sacramento, CA;
authors: J Nilas
authors: JN
authors: Young
authors: Department of Surgery Division of Plastic and Reconstructive Surgery, UC Davis School of Medicine, Sacramento, CA.
authors: Michael S
authors: MS
authors: Wong