A new method for sternal closure after vacuum-assisted therapy in deep sternal infections following cardiac surgery

Abstract

The treatment of nonhealing and infected sternotomies following cardiac surgery is a challenging task, with increased rates of mortality and morbidity, as well as high costs. Local vacuum therapy (VAC. sytem) permits the treatment of deep sternal infections due to continuous aspiration and a sealed dressing which stimulates granulation tissue formation. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep wound infection enhances sternal preservation and the speed of potential rewiring. After some weeks of VAC-therapy a complete preparation of the substernal structures is necessary. In this context laceration of the right ventricle is a rare, but life-threatening complication. We present a new technique for sternal closure after vacuum-assisted wound treatment using Nitinol clips which can prevent these severe complications. Without any preparation of the substernal tissue the clips can be inserted in the parasternal space with consecutive proper stabilization of the sternum. This new method represents an easy, low-cost and complication-free procedure.