The Use of Vacuum-Assisted Closure in Purulent Complications and Difficult-To-Heal Wounds in Cardiac Surgery.

Abstract

Sternal wound infections are aserious and potentially fatal complication of cardiac surgery. The aim of the study was to analyze the results of using the vacuum-assisted closure (VAC) system over a4-year period. Quantitative VAC performance data from aretrospective review of aconsecutive cohort of 47patients treated with VAC for post-cardiac surgery wound complications were collected and statistically analyzed. In the study group35patients developed infections of the post-operative chest wound. In 12 other patients wound dehiscence was observed, but repeated cultures did not reveal the presence of any bacteria. The statistical analysis identified the following as significant risk factors: age, female sex, being overweight, ahigh total logistic EuroScore, the use of both internal thoracic arteries for bypass grafting, and diabetes. In the wound negative culture group the total length of hospital stay was significantly shorter than in the wound positive culture group. Mortality in this group was 0.0% vs. 5.7% in the wound positive culture group. In the study material, Gram-negative bacteria were responsible for 77% of the post-operative wound infections, with only 14% Gram-positive wound cultures. No complications were related to VAC use. The use of negative-pressure wound therapy with other concomitant surgical procedures is agood method of treating infected wounds as well as non-contaminated dehiscence of the wound and sternum. Considering that most of the infections within the authors' department are caused by Gram-negative bacteria, it would be beneficial to consider modifying the model of preventive antibiotic treatment to cover the Gram-negative spectrum in addition to the Gram-positive bacteria currently targeted.