Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection
| Autor: | Eusebio Merico, Milva Ballardini, Alberto Costantino, Marcello Masala, Claudio D’Andrea, Paolo Sordini, Luigi Mosillo, Maria Pia Tocco |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Sternum medicine.medical_specialty medicine.medical_treatment Aortic valve replacement Negative-pressure wound therapy medicine Humans Surgical Wound Infection Prospective Studies Cardiac Surgical Procedures Surgical Flaps CLIPS Aged computer.programming_language Aged 80 and over Postoperative Care business.industry Mediastinum General Medicine Middle Aged medicine.disease Combined Modality Therapy Mediastinitis Anti-Bacterial Agents Cardiac surgery Surgery Treatment Outcome medicine.anatomical_structure Anesthesia Female Cardiology and Cardiovascular Medicine business computer Negative-Pressure Wound Therapy |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 35:833-838 |
| ISSN: | 1010-7940 |
| Popis: | Objective: Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. Methods: From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in anotherinstitution,was closedusing sternalwires.Results:We hadno mortality; wound healingwas successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14— 37 days). Conclusions: VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and noninvasive option for sternal resynthesis. After VAC therapy, a reduction in number of muscular flaps used and an increase of direct sternal resynthesis were observed. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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