Purpose: Vacuum Assisted Closure™ (VAC^®) therapy has gained widespread use since its introduction in 1996. Previous studies have attributed significant benefit to the use of VAC^® therapy for treatment of sternal wounds with or without mediastinitis. Management of sternal wounds with VAC^® therapy has been shown to decrease the number of dressing changes, reduce the time between debridement and definitive closure, and reduce costs associated with a protracted course of in-hospital dressing changes. VAC^® therapy has been used both as a bridge between debridement and definitive closure and as a catalyst to secondary sternal wound healing. We describe the largest published experience with VAC^® therapy for sternal wounds/mediastinitis. Methods: We performed a retrospective review of 103 consecutive patients who underwent VAC^® therapy after median sternotomy between June 1999 and March 2004 at a single institution. The wounds were classified as sterile wounds, superficial sternal infections, and mediastinitis. The wound VAC^®, consisting of a polyurethane sponge and evacuation tube with in-line suction, was applied sterilely to all wounds over a layer of Acticoat™ (Westaim Biomedical™). Results: The VAC^® was utilized in the treatment of sternal wounds for 103 patients, 67 male and 36 female, whose mean age was 52.4 years (range 3 months to 91 years). Our patient comorbidities included diabetes, COPD, end stage renal disease, immunosuppression and others. 66% of the patients had a diagnosis of mediastinitis whereas 34% had either superficial infections or a sterile wound. The VAC^® was utilized for an average of 10.8 days per patient. 71% (73/103) of the patients had definitive chest closure with either ORIF or flap closure. The remaining 29% were allowed to close by secondary intention. Our overall mortality rate was 25% (26/103), although no deaths were directly related to the use of VAC^® therapy, and only one death was a direct consequence of mediastinitis. Conclusions: We report the largest series of patients treated with VAC^® therapy for post-sternotomy sternal wounds. We feel the VAC^® is safe and effective as a first line therapy in the management of sternal wounds. Our mortality rate represents the patients’ underlying disease process and comorbidities and is not a reflection of VAC^® associated complications. The VAC^® has been shown to decrease wound edema, decrease the time to definitive closure and reduce wound bacterial colony counts. We implement VAC^® therapy for all patients with sternal wounds/mediastinitis at our institution, and feel that it should be a standard protocol in the first line management of these types of wounds. Disclaimer: None of the authors have commercial or financial interests in Vacuum Assisted Closure™, KCI^® International, and Westaim Biomedical™.
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