ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Ronny Gustafsson
Johan Sjögren
Richard Ingemansson
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wackenfors, A.
Right arrow Articles by Malmsjö, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wackenfors, A.
Right arrow Articles by Malmsjö, M.
Related Collections
Right arrow Chest wall

Ann Thorac Surg 2005;79:1724-1730
© 2005 The Society of Thoracic Surgeons

Original articles: General thoracic

Blood Flow Responses in the Peristernal Thoracic Wall During Vacuum-Assisted Closure Therapy

Angelica Wackenfors, MSa,*, Ronny Gustafsson, MDb, Johan Sjögren, MDb, Lars Algotsson, MD, PhDc, Richard Ingemansson, MD, PhDb, Malin Malmsjö, MD, PhDa

a Department of Internal Medicine, Lund University Hospital, Lund, Sweden
b Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden
c Department of Cardiothoracic Anesthesia, Lund University Hospital, Lund, Sweden

Accepted for publication October 28, 2004.

* Address reprint requests to Ms Wackenfors, Experimental Vascular Research, BMC A13, SE-221 84 Lund, Sweden (E-mail: angelica.wackenfors{at}med.lu.se).

BACKGROUND: Vacuum-assisted closure (VAC) therapy is a recently introduced method for the treatment of poststernotomy mediastinitis. The aim of this study was to examine the effects of negative pressure on peristernal soft tissue blood flow and metabolism because the mechanisms by which vacuum-assisted closure therapy promotes wound healing are not known in detail.

METHODS: Microvascular blood flow was examined by laser Doppler velocimetry in an uninfected porcine sternotomy wound model. Microvascular blood flow was examined in the muscular and subcutaneous tissue, at different distances from the wound edge, after the application of –50 to –200 mm Hg. Wound fluid pH, partial pressures of oxygen and carbon dioxide, bicarbonate, and lactate were analyzed after 0, 30, and 60 minutes of continuous negative pressure.

RESULTS: Vacuum-assisted closure therapy induced an increase in the microvascular blood flow a few centimeters from the wound edge. In muscular tissue, the distance from the wound edge to the position at which the blood flow was increased was shorter than that in subcutaneous tissue. Close to the wound edge, relative hypoperfusion was observed. The hypoperfused zone was larger at high negative pressures and was especially prominent in subcutaneous tissue. Wound fluid partial pressure of oxygen and lactate levels were increased after 60 minutes of vacuum-assisted closure therapy, which may be the result of changes in the microvascular blood flow.

CONCLUSIONS: Vacuum-assisted closure therapy induces a change in microvascular blood flow that is dependent on the pressure applied, the distance from the wound edge, and the tissue type. It may be beneficial to tailor the negative pressure used for vacuum-assisted closure therapy according to the wound tissue composition. Wound fluid partial pressure of oxygen and lactate levels increased during vacuum-assisted closure therapy. This combination is known to promote wound healing.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
M. B. Steigelman, K. C. Norbury, D. V. Kilpadi, and J. D. McNeil
Cardiopulmonary effects of continuous negative pressure wound therapy in Swine.
Ann. Thorac. Surg., October 1, 2009; 88(4): 1277 - 1283.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Malmsjo, R. Petzina, M. Ugander, H. Engblom, C. Torbrand, A. Mokhtari, R. Hetzer, H. Arheden, and R. Ingemansson
Preventing heart injury during negative pressure wound therapy in cardiac surgery: Assessment using real-time magnetic resonance imaging
J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 712 - 717.
[Abstract] [Full Text] [PDF]

Home page
 SURG INNOVHome page
B. Z. Atkins, M. K. Wooten, J. Kistler, K. Hurley, G. C. Hughes, and W. G. Wolfe
Does Negative Pressure Wound Therapy Have a Role in Preventing Poststernotomy Wound Complications?
Surgical Innovation, June 1, 2009; 16(2): 140 - 146.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Vicchio, M. De Feo, G. Caianiello, and M. Cotrufo
Vacuum for Pediatric Post-Sternotomy Mediastinitis: The Role of Laser Doppler Velocimetry in the Establishment of Adequate Subatmospheric Pressure Intensity
Ann. Thorac. Surg., October 1, 2008; 86(4): 1399 - 1399.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Petzina, M. Ugander, L. Gustafsson, H. Engblom, R. Hetzer, H. Arheden, R. Ingemansson, and M. Malmsjo
Topical negative pressure therapy of a sternotomy wound increases sternal fluid content but does not affect internal thoracic artery blood flow: Assessment using magnetic resonance imaging.
J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1007 - 1013.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
C. Schimmer, S.-P. Sommer, M. Bensch, and R. Leyh
Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers
Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 708 - 711.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Lindstedt, M. Malmsjo, and R. Ingemansson
Blood Flow Changes in Normal and Ischemic Myocardium During Topically Applied Negative Pressure
Ann. Thorac. Surg., August 1, 2007; 84(2): 568 - 573.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Vicchio, A. Amato, E. Merlino, A. Nava, M. De Feo, G. Caianiello, and M. Cotrufo
Treatment of deep thoracotomy wound infection in neonatal age: A case report
J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 254 - 255.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Petzina, M. Ugander, L. Gustafsson, H. Engblom, J. Sjogren, R. Hetzer, R. Ingemansson, H. Arheden, and M. Malmsjo
Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging
J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1154 - 1162.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. Sjogren, M. Malmsjo, R. Gustafsson, and R. Ingemansson
Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm
Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 898 - 905.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Mokhtari, R. Petzina, L. Gustafsson, J. Sjogren, M. Malmsjo, and R. Ingemansson
Sternal stability at different negative pressures during vacuum-assisted closure therapy.
Ann. Thorac. Surg., September 1, 2006; 82(3): 1063 - 1067.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
R. Petzina, L. Gustafsson, A. Mokhtari, R. Ingemansson, and M. Malmsjo
Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting.
Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 85 - 89.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2005 by The Society of Thoracic Surgeons.