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ICVTS on-line discussion B VAC therapy in post cardiac surgery deep sternal wound infection

PSHC, King Fahd Medical City, Riyadh 11525, Saudi Arabia

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

eComment: We read with interest the paper by Raja and colleagues [1] that raised the question of whether vacuum-assisted closure (VAC) therapy should be used routinely for the management of deep sternal wound infection following cardiac surgery. I agree with the conclusion of the authors that VAC therapy is especially useful in high-risk patients with sternal osteomyelitis as an attractive first line therapy. We have been using VAC therapy for the management of post cardiac surgery deep sternal wound infection since its introduction in the early 1990's. In our early experience, we used it as our first and definitive line of management for all deep sternal wound infections. This definitely led to a reduction in our rate of surgical procedures in the form of sternal debridement, closed irrigation, sternal rewiring, and flaps. Our initial experience was similar to that of Lund University Hospital group [2] and the experience of Agarwal et al. [3]. Although there was a significant reduction in the number of dressing changes and the number of tissue flaps and the surgical interventions required. There was a marked increase in the hospital stay required by every patient with consequent increase in the cost of therapy. This has led us to modify our protocol of using VAC therapy. We use it now as an initial management only for high risk patients with associated high surgical risk. VAC therapy leads to:

1. reduction in the number of dressing changes,
   
2. stabilization of the flail chest caused by the unstable sternum which leads to improvement in gas exchange,
   
3. reduction of the risk associated with major surgical correction in unstable patients.
   

In case of low risk patients, we tend to go directly with early surgical revision, debridement, rewiring or early flap reconstruction.

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Top References

 

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]
2. Sjogren J, Nilsson J, Gustafsson R, Malmsjo M, Ingemansson R. The impact of vacuum-assisted closure on long-term survival after poststernotomy mediastinitis. Ann Thorac Surg 2005; 80:1270–1275.[Abstract/Free Full Text]
3. Agarwal JP, Ogilivie M, Wu LC, Lohman RF, Gottlieb LJ, Franczk M, Song DH. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg 2005; 116:1035–1040.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohamed F. Ibrahim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ibrahim, M. F. Articles by Refaat, A. A. Search for Related Content PubMed PubMed Citation Articles by Ibrahim, M. F. Articles by Refaat, A. A. Related Collections Related Article