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Ann Thorac Surg 2005;80:2205-2212
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Vacuum-Assisted Wound Closure of Deep Sternal Infections in High-Risk Patients After Cardiac Surgery

Division of Plastic Surgery, St. Michael's Hospital, and the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Accepted for publication April 4, 2005.

^_* Address correspondence to Dr Mahoney, Division of Plastic Surgery, St. Michael's Hospital, Room 4-080, 30 Bond St, Toronto, ON M5B 1W8, Canada (Email: james.mahoney{at}utoronto.ca).

BACKGROUND: Sternal wound infections are a serious complication arising from cardiac surgery. Recently, the general application of negative pressure to wounds by vacuum-assisted closure (VAC) therapy has shown enhanced granulation and wound contraction. Here we examine the effect of VAC on sternal wounds.

METHODS: We collected and statistically analyzed quantitative VAC performance data and outcomes with a retrospective review on a consecutive cohort of 22 patients treated with VAC for post–cardiac surgery wound complications.

RESULTS: Sternal wound infections became evident on average at 21.0 days after surgery, associated with dehiscence (82%), sternal instability (59%), fluid collection by computed tomography (73%), and osteomyelitis (41%). Cultures most commonly identified Staphylococcus aureus (50%). Prompt irrigation and debridement were performed on all patients, and VAC therapy was applied at approximately 7.3 days after diagnosis. Vacuum-assisted closure induced granulation of 71% of the sternal wound area by 7 days, with a daily drainage of approximately 84 mL. By 14 days, there was a 54% reduction in wound size, and patients were discharged after approximately 19.5 days and placed on home therapy. Vacuum-assisted closure was discontinued at approximately 36.7 days with an average reduction in sternal wound size of 80%. Extensive secondary surgical closure, requiring muscle flaps, was avoided in 64% of patients, whereas 28% of patients required no surgical reconstruction for wound closure. No complications were related to VAC use.

CONCLUSIONS: In contrast to our earlier studies, adjunctive VAC therapy markedly reduced required surgical interventions, reoperation for persistent infections, and the hospitalization period. Thus, VAC provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after medial sternotomy.

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