The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery

被引:124
作者
Fleck, TM
Fleck, M
Moidl, R
Czerny, M
Koller, R
Giovanoli, P
Hiesmayer, MJ
Zimpfer, D
Wolner, E
Grabenwoger, M
机构
[1] Univ Vienna, AKH Vienna, Dept Cardiothorac Surg, A-1090 Vienna, Austria
[2] Univ Vienna, Dept Plast & Reconstruct Surg, A-1090 Vienna, Austria
关键词
D O I
10.1016/S0003-4975(02)03948-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation. Methods. Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement. Results. Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%. Conclusions. The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery. (C) 2002 by The Society of Thoracic Surgeons.
引用
收藏
页码:1596 / 1600
页数:5
相关论文
共 20 条
[11]   Management of the infected median sternotomy wound with muscle flaps - The emory 20-year experience [J].
Jones, G ;
Jurkiewicz, MJ ;
Bostwick, J ;
Wood, R ;
Bried, JT ;
Culbertson, J ;
Howell, R ;
Eaves, F ;
Carlson, G ;
Nahai, F .
ANNALS OF SURGERY, 1997, 225 (06) :766-776
[12]   INFECTED MEDIAN STERNOTOMY WOUND - SUCCESSFUL TREATMENT BY MUSCLE FLAPS [J].
JURKIEWICZ, MJ ;
BOSTWICK, J ;
HESTER, TR ;
BISHOP, JB ;
CRAVER, J .
ANNALS OF SURGERY, 1980, 191 (06) :738-744
[13]   STERNAL WOUND COMPLICATIONS AFTER ISOLATED CORONARY-ARTERY BYPASS-GRAFTING - EARLY AND LATE MORTALITY, MORBIDITY, AND COST OF CARE [J].
LOOP, FD ;
LYTLE, BW ;
COSGROVE, DM ;
MAHFOOD, S ;
MCHENRY, MC ;
GOORMASTIC, M ;
STEWART, RW ;
GOLDING, LAR ;
TAYLOR, PC .
ANNALS OF THORACIC SURGERY, 1990, 49 (02) :179-187
[14]   Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation [J].
Morykwas, MJ ;
Argenta, LC ;
SheltonBrown, EI ;
McGuirt, W .
ANNALS OF PLASTIC SURGERY, 1997, 38 (06) :553-562
[15]   Vacuum-assisted closure in the treatment of poststernotomy mediastinitis [J].
Obdeijn, MC ;
de Lange, MY ;
Lichtendahl, DHE ;
de Boer, WJ .
ANNALS OF THORACIC SURGERY, 1999, 68 (06) :2358-2360
[16]   Prospective trial of catheter irrigation and muscle flaps for sternal wound infection [J].
Rand, RP ;
Cochran, RP ;
Aziz, S ;
Hofer, BO ;
Allen, MD ;
Verrier, ED ;
Kunzelman, KS .
ANNALS OF THORACIC SURGERY, 1998, 65 (04) :1046-1049
[17]  
SHUMACKER HB, 1963, ARCH SURG-CHICAGO, V86, P384
[18]   Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection [J].
Tang, ATM ;
Ohri, SK ;
Haw, MP .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2000, 17 (04) :482-484
[19]  
Webb LX, 2001, UNFALLCHIRURG, V104, P918, DOI 10.1007/PL00002776
[20]   Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery [J].
Yasuura, K ;
Okamoto, H ;
Morita, S ;
Ogawa, Y ;
Sawazaki, M ;
Seki, A ;
Masumoto, H ;
Matsuura, A ;
Maseki, T ;
Torii, S .
ANNALS OF SURGERY, 1998, 227 (03) :455-459