Vacuum assisted closure helps combat infection

Link: Interactive CardioVascular and Thoracic Surgery.

     Consensus exists that early recognition of sternal wound infection is crucial to prevent involvement and destruction of the sternal bone, which prohibits secondary sternal closure and necessitates the use of muscle flaps for wound closure. Since November 2001 to September 2005, 125 patients received a VAC system after surgical debridement. Thirty-eight patients had a superficial infection (2A) and 87 patients had a deep infection (2B). From those, 59 patients underwent secondary sternal closure after VAC therapy, whereas 28 patients needed muscle flap closure. The time of diagnosis of sternal infection had great impact on the outcome. It was made on POD 10.6�8.3 in the 2A group, and on POD 13.2�11.1 in the 2B group. In the patients from Group 2A who had a recurrence of infection, the initial diagnosis of infection was made on POD 13.1�11.1. In patients where an SC was possible the time of diagnosis was on POD 11.1�6.6 whereas POD 17.7�16.2 in the MF group. The key to successful management of sternal wound infection is early recognition and aggressive treatment with reopening of the entire wound and sternum, which seems mandatory to achieve a low recurrence rate.