Vacuum-assisted Closure as a Treatment Modality for Surgical Site Infection in Cardiac Surgery


Authors: M. Šimek 1;  P. Němec 1;  B. Zálešák 2;  R. Hájek 1;  M. Kaláb 1;  I. Fluger 1;  M. Kolář 3;  L. Ječmínková 1;  P. Gráfová 1
Authors‘ workplace: Kardiochirurgická klinika, přednosta: doc. MUDr. P. Němec, CSc. 1;  Oddělení plastické a estetické chirurgie, přednosta: MUDr. B. Zálešák, Ph. D. 2;  Ústav mikrobiologie, antibiotické centrum, přednostka: doc. MUDr. D. Koukalová, CSc. FN a LF Univerzity Palackého v Olomouci 3
Published in: Rozhl. Chir., 2007, roč. 86, č. 8, s. 404-409.
Category: Monothematic special - Original

Overview

Background:
The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection.

Methods:
From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system™, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 ± 9.7 years and the median BMI was 33.2 ± 5.0 kg/m². Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%).

Results:
Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 ± 22.6 days. The median number of dressing changes was 4.6 ± 1.8. The median VAC treatment time until surgical closure was 9.7 ± 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy.

Conclusion:
The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

Key words:
surgical site infection – vacuum-assisted closure – deep sternal infection – cardiac surgery


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Surgery Orthopaedics Trauma surgery
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