Role of vacuum assisted suction drainage in management of deep sternal wound infection: Experience in one center

Abstract

BackgroundDeep sternal wound infection (DSWI) is a life threatening complication of a median sternotomy. This study was conducted in Zagazig University Hospital in the period from Marsh 2014 to September 2016, to evaluate use of vacuum (VAC) in treatment of DSWI. MethodsTwelve patients with DSWI out of 840 median sternotomy procedures for coronary artery bypass graft (CABG), valve replacement, valve repair, adult congenital heart disease and mediastinal tumors which needed median sternotomy were collected; Radical debridement of the wounds was performed; sterile foam with drain was placed in the wound which was covered with sterile OPSITE dressing; the drain being connected to a suction unit maintaining −100 mmHg pressure except wounds in which the cardiac surface directly touches the device we used minimum low negative pressure of −50 mmHg because of the fear of hemorrhage and impairment of cardiac function.Follow up for 3–6 months after vacuum therapy was done to detect any morbidity or recurrence. ResultsPatients with DSWI in our study were managed with this therapy. They were twelve patients. 7 were males and 5 females. Mean age was 66 years. Excellent wound healing occurred in eleven patients (91.7%), with no mortality while one patient (8.3%) had relapse (multiple sinuses appeared). This patient had multiple risk factors. The organisms isolated from his wound were Staphylococcus epidermis, Pseudomonas aeruginosa and Candida albicans. This patient required omental flap to fill the defect after radical debridement of the wound combined with a VAC therapy system and intravenous antifungal therapy, these led to this patient's favorable outcome. ConclusionsThe incidence of DSWI was similar in our center to that in other cardiothoracic centers. Various risk factors were found to be associated with DSWI. The DSWI pathogens in our center are similar to those in other reports most of our patients were treated successfully with this technique with excellent wound healing. So, vacuum therapy is safe and effective method for treating DSWI.