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ICVTS on-line discussion A Multiple modalities for deep sternal wound infection management

Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 70124, Taiwan

Should vacuum-assisted closure therapy be routinely used for management of deep sternal wound infection after cardiac surgery?

eComment: Vacuum-assisted closure (VAC) therapy is one of the effective and safe adjunctive modality for managing post-cardiac surgery deep sternal wound infection [1]. However, management of the deep sternal wound should combine with all methods to eradicate the infectious foci and then the curative goal will be achievable.

A 54-year-old male patient suffering from aortic root aneurysm with coronary artery disease received Bentall's operation combined with coronary bypass grafting surgery, all uneventful. However, two months later, when he came back to the out-patient clinic, he was noted with sternal wound infection. Aggressive debridement surgery was arranged. On the operative theatre, synthetic aortic graft bleeding was noted. Deep sternal wound infection with graft invasion was noted, emergent aortic graft replacement was done. One month later, his infectious condition recurred. We re-did Bentall's operation again to eradicate the prosthetic valve endocarditic foci, closely irrigated the wound with copious beta-iodine solution, and then utilized VAC therapy to hasten the clearance and healing rate of the sternal wound. After all prompt management, this patient received bilateral pectoris major muscle flap reconstruction. From the above described patient, we know the prompt management of the patient should combine all modalities to eradicate the infectious foci and adjunctive therapies to accelerate the wound healing process, only through this can the patient get healthy again.

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1. Raja SG, Berg GA. Should vacuum-assisted closure therapy be routinely used for management of deep sternal wound infection after cardiac surgery? Interact CardioVasc Thorac Surg 2007; 6:523–528.[Abstract/Free Full Text]

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