Vacuum assisted closure therapy for poststernotomy mediastinitis: Definitive or bridge to reconstruction

Background

Vacuum assisted closure (VAC) system is used to promote granulation tissue formation and hence, wound healing in chronic difficult wounds when all traditional treatment strategies fail. The idea behind the device was introduced in 1997 which is simply putting the wound under continuous and controlled negative suction pressure inducing arteriolar vasodilation and wound stability.

Methods

17 patients (with a mean age of 65.8 ± 5.3 years (range 58–79 years) who were diagnosed with poststernotomy mediastinitis after cardiac surgery received VAC system during the course of their treatment. 11patients [64.7%] underwent coronary artery bypass grafting [CABG], 3 [17.6%] mitral valve replacement [MVR], 2 [11.7%], aortic valve replacement and 1 [5.8%]) Bental operation. Total operative time ranged between 145 and 300 min with a mean of 216.7 ± 45.5 min. 7 [41.1%] patients required exploration for mediastinal bleeding.

Results

Healing by secondary intention was achieved in 7 [41.2%] patients without the need of any further surgery. In 6 [35.3%] patients, primary closure of the wound in layers could be achieved after discontinuation of the VAC therapy. In the remaining 4 [23.5%] patients, the VAC therapy was considered as a bridge to further reconstruction with pectoral muscle flap. Of the group who received pectoral muscle flap, one [5.88%] patient died.

Conclusions

VAC therapy can be considered as good alternative to more aggressive surgery that might not be suitable for some patients during certain times of their treatment course.