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Ann Thorac Surg 2007;83:2246-2247
© 2007 The Society of Thoracic Surgeons

How To Do It

New Method for Sternal Closure After Vacuum-Assisted Therapy in Deep Sternal Infections After Cardiac Surgery

Nils Reiss, MD*, Ulrich Schuett, MD, Michael Kemper, MD, Andreas Bairaktaris, MD, Reiner Koerfer, MD

Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany

Accepted for publication July 18, 2006.

* Address correspondence to Dr Reiss, Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hopital, Paris, Cedex 13, 75651, France. (Email: nreiss{at}gmx.de).

The treatment of nonhealing and infected sternotomies after cardiac surgery is a challenging task with increased rates of mortality and morbidity, as well as high costs. A local vacuum therapy (ie, the vacuum-assisted closure system) permits the treatment of deep sternal infections due to continuous aspiration and a sealed dressing that stimulates granulation tissue formation. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep wound infection enhances sternal preservation and the speed of potential rewiring. After some weeks of vacuum-assisted closure therapy, a complete preparation of the substernal structures is necessary. In this context, laceration of the right ventricle is a rare but life-threatening complication. We describe a new technique for sternal closure after vacuum-assisted wound treatment using Nitinol clips (Praesidia, Bologna, Italy), which can prevent these severe complications. Without any preparation of the substernal tissue the clips can be inserted in the parasternal space with consecutive proper stabilization of the sternum. This new method represents an easy, low-cost and complication-free procedure.






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Copyright © 2007 by The Society of Thoracic Surgeons.