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Oral Abstracts (Session 2 of 5)
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Moderator: John M. MacDonald, MD, FACS (Presentation 33.3) Vacuum-assisted closure treatment of sternal wound infections following cardiac surgery James L. Mahoney, MD, FRCSC; Laura Teague, RN, MN, ACNP; Kyle Cowan, BSc, PhD, St Michael’s Hospital, Toronto, Ontario, Canada Abstract: Sternal wound infections, while relatively uncommon, are a serious complication arising from cardiac surgery.1 Recently, the general application of negative pressure to wounds by Vacuum-Assisted Closure® (V.A.C. Therapy®) has shown enhanced granulation and closure.2 Here, we quantitatively describe the use of V.A.C. for the treatment of post-cardiac surgery mediastinitis in 22 patients. Mediastinal infections became evident at ~21.0 days post-surgery, with pain (100%), erythema (54.5%), discharge (95.4%), dehiscence (81.8%), and sternal instability (59.1%). A computed tomography scan reported fluid collections in 72.7% of patients, and cultures most commonly identified Staphylococcus aureus (50.0%), with osteomyelitis being present in 40.9%. Prompt irrigation and debridement was performed on all patients and V.A.C. therapy was applied at ~7.3 days following diagnosis. Treatment settings ranged between -75 to -125mmHg with 13.6% on intermittent therapy. V.A.C. induced granulation of 71.1% of the sternal wounds by 7 days, with a daily drainage of ~84.4mls. By 14 days, there was a 53.9% reduction in wound size, and patients were discharged after ~19.5 days on home therapy. VAC was discontinued at approximately 36.7 days with an average reduction in sternal wound size of 80.3%. Secondary surgical closure was avoided in 63.7% of patients; the remainder received regional flaps. One unrelated death occurred, while all others survived with complete wound healing. No complications were related to V.A.C. use. In contrast to our earlier work,3 adjunctive V.A.C. therapy showed a marked reduction in required surgical interventions, re-operation for persistent infections, and hospitalization period. Thus, V.A.C. provides a viable and efficacious method by which to treat post-operative mediastinitis. References 1. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030–1036. 2. Argenta LC, Morykwas MJ. Vacuum assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563–577. 3. Bray PW, Mahoney JL, Anastakis D, Yao JK. Sternotomy infections: sternal salvage and the importance of sternal stability. Can J Surg. 1996;39(4):297–301. |
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