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Ann Thorac Surg 2002;74:1596-1600
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery

Tatjana M. Fleck, MDa*, Michael Fleck, CMa, Reinhard Moidl, MDa,b, Martin Czerny, MDa, Rupert Koller, MDb, Pietro Giovanoli, MDb, Michael J. Hiesmayer, MDb, Daniel Zimpfer, CMb, Ernst Wolner, MDa, Martin Grabenwoger, MDa

a Departments of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
b Plastic and Reconstructive Surgery, University of Vienna, Vienna, Austria

Accepted for publication June 26, 2002.

* Address reprint requests to Dr Fleck, Department of Cardiothoracic Surgery, University of Vienna, AKH Vienna, Leitstelle 20A, Währinger Gürtel 18-20, 1090 Vienna, Austria.
e-mail: t9204604{at}hotmail.com

BACKGROUND: The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation.

METHODS: Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement.

RESULTS: Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%.

CONCLUSIONS: The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery.




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