title: The Use of Vacuum-Assisted Closure in Purulent Complications and Difficult-To-Heal Wounds in Cardiac Surgery.
abstract: BACKGROUND
  Sternal wound infections are a serious and potentially fatal complication of cardiac surgery.
  
  
  OBJECTIVE
  The aim of the study was to analyze the results of using the vacuum-assisted closure (VAC) system over a 4-year period.
  
  
  METHODS
  Quantitative VAC performance data from a retrospective review of a consecutive cohort of 47 patients treated with VAC for post-cardiac surgery wound complications were collected and statistically analyzed. In the study group 35 patients developed infections of the post-operative chest wound. In 12 other patients wound dehiscence was observed, but repeated cultures did not reveal the presence of any bacteria.
  
  
  RESULTS
  The statistical analysis identified the following as significant risk factors: age, female sex, being overweight, a high total logistic EuroScore, the use of both internal thoracic arteries for bypass grafting, and diabetes. In the wound negative culture group the total length of hospital stay was significantly shorter than in the wound positive culture group. Mortality in this group was 0.0% vs. 5.7% in the wound positive culture group. In the study material, Gram-negative bacteria were responsible for 77% of the post-operative wound infections, with only 14% Gram-positive wound cultures. No complications were related to VAC use.
  
  
  CONCLUSIONS
  The use of negative-pressure wound therapy with other concomitant surgical procedures is a good method of treating infected wounds as well as non-contaminated dehiscence of the wound and sternum. Considering that most of the infections within the authors' department are caused by Gram-negative bacteria, it would be beneficial to consider modifying the model of preventive antibiotic treatment to cover the Gram-negative spectrum in addition to the Gram-positive bacteria currently targeted.
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Mariusz J
authors.initials: MJ
authors.lastname: Listewnik
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Sielicki
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mokrzycki
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Biskupski
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Mirosław
authors.initials: M
authors.lastname: Brykczyński
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing