Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience
Tatjana M. Fleck 1*,
Bernhard Kickinger 1,
Reinhard Moidl 2,
Ferdinand Waldenberger 1,
Ernst Wolner 1,
Martin Grabenwoger 2,
Wilfried Wisser 1
1 AKH Vienna, Austria
2 KH Hietzing, Vienna, Austria
* To whom correspondence should be addressed. E-mail: t9204604{at}hotmail.com.
 |
Abstract |
|---|
The management of open chest with the vacuum assisted closure (VAC) system was evaluated in terms of impact on cardiac hemodynamics, respiratory parameters, complications, incidence of wound infection, overall handling and outcome in 22 patients during 2005 and 2008 after cardiac surgery. The decision to leave the sternum open was made electively in all patients at the time of primary operation or reexploration. In 4 patients the VAC was implanted during the primary operation. In the remainder the VAC was implanted after a mean of 5 days after the primary operation. The overall mortality rate was 45% (10/22). None of the patients developed a sternal wound infection, nor where there any VAC related complications. Management of open chest with the VAC system can be considered as an alternative to sterile draping. The VAC has no negative impact on cardiac hemodynamics as well as respiratory mechanics. The feared complication of right ventricular rupture and massive bleeding can be effectively prevented. Through the stabilizing of the thoracic cage, the patient can be easily moved and mobilized for nursing reasons and pneumonia prevention. Furthermore the VAC effectively prevents the contamination of the wound and the mediastinum with potential subsequent infection. Keywords: Mediastinal infection; Hemodynamics; Wound closure
