Wednesday, October 13, 2004 - 7:35 AM
6393

Vacuum Assisted Closure™ for Sternal Wounds: A First Line Therapeutic Management

Jayant P. Agarwal, MD, Michael P. Ogilvie, MD, Liza C. Wu, MD, Robert F. Lohman, MD, Lawrence J. Gottlieb, MD, Mietka Franczyk, PT, PhD, and David H. Song, MD.

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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