[Results of vacuum-assisted wound closure system in the treatment of sternotomy wound infections following cardiac surgery].

In the last decade a new and more effective method--the vacuum assisted wound closure (VAC)--was introduced for the treatment of the mediastinal wound infections following open heart operations. This technique gained a widespread acceptance in many countries of the world. The Centre of Cardiac Surgery of the University of Debrecen was the first to apply this treatment in Hungary. The authors evaluated the VAC therapy in a retrospective study at their institute. Between September 2002 and December 2005 62 consecutive patients were treated with this method because of wound infection in median sternotomy. Median age of 42 males and 20 females was 63,1 +/- 6,8 years (42-75). All patients had heart surgery (cardio pulmonary bypass) before they developed superficial or deep wound infection in their sternotomy site. Following exploration and radical debridement of the sternotomy wounds, VAC method was used for the treatment of infected wounds until suppuration stopped. When the wound had become macroscopically clear, reconstruction of the sternal defect was performed. This was carried out with well vascularized soft tissue flap(s) (major pectoral muscle and/or omental or pericardial fat pad) in 34 patients, sternal refixation was performed in 13 cases, while 11 patients underwent delayed secondary wound reconstruction with sutures. In one case Ley-prosthesis (sternal stabilisator metal prosthesis) was implanted. Three patients died before the sternal wound reconstruction. As a result of VAC therapy, all infected mediastinal wound cleaned up rapidly and formation of granulation tissue began. The mean period of time from the first sign of the infection to hospital discharge of the patients was 42.2 +/- 18.5 (5-185) days, while the same between sternal reconstruction and discharge was 19.9 +/- 9.6 (1-63) days. The mean duration of VAC therapy was 7.9 +/- 3.4 (1-21) days. The hospital mortality was 11.3% (7/62). Recurrence of the infection occurred in two patients (3.6%). These results suggest that Vacuum-assisted Closure system is an effective and safe method for the treatment of sternotomy wound infections following cardiac surgery. This method facilitates early clean up of infected sternotomy wounds and decreases the recurrence rate significantly.