Value of VAC®-therapy in the treatment of sternal infections

Osteomyelitis of the sternum is a dreaded complication after sternotomy and is related to high mortality. Control of infection by radical debridement is the key to successful treatment. Instability of the thoracic cage can lead to a high complication rate. 16 Patients with an infected and unstable sternum underwent radical debridement with resection of the sternum and adjacent ribs. 6 Patients (group A) received an immediate defect coverage with a pedicled muscle flap. 10 Patients (group 13) were treated with a vacuum-assisted closure (V.A.C.(R))-therapy until stabilization of their general condition and underwent defect coverage in a second operation. Healing of the flaps was uneventful in all cases despite minor problems. 5 patients of group A had severe complications with pulmonal or cardiac failure and thoracic instability which lead to prolonged periods of mechanical ventilation. 2 patients of this group died due to multi organ failure. All patients of group B survived and there were no major complications. All of the patients were free of recurrence from their osteomyelitis during follow-up. V.A.C.(R)-therapy after radical resection of sternum osteomyelitis proved to be an effective measure to bridge time while optimizing the status of the patient and it's wound. With this approach we believe to have lowered the rate of major complications in this multimorbid patient group by reducing the burden of one large operation and by improving thoracic stability.