The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis – a single center experience with 54 patients

Ina C Ennker,Detlef Pietrowski,Juergen Ennker,Peter M Vogt,Anita Malkoc,Alexander Albert

doi:10.1186/1749-8090-4-5

Abstract

Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007.

Highlights

Poststernotomy mediastinitis or deep sternal infection (DSI), is a serious cause of postoperative morbidity and mortality in cardiac surgery patients
We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007
We present an analysis of all consecutive patients suffering from DSI after cardiac surgery between January 2005 and April 2007 in our centre

Summary

Introduction

Poststernotomy mediastinitis or deep sternal infection (DSI), is a serious cause of postoperative morbidity and mortality in cardiac surgery patients. A wide range of wound-healing strategies have been established until now for treatment of this often devastating complication. Negative pressure wound therapy was first introduced by Argenta and Morykwas [4,5] and has become a widely used, efficacious and reliable method for managing different types of open wounds (e.g. abdomen, head, neck) after infection. In cardiac surgery it is frequently applied for treating patients suffering from deep sternal wound infections. The strategy for surgical wound debridement is not standardised and varies significantly from surgeon to surgeon

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Conclusion