The use of vacuum assisted closure system (vac) in the treatment of postoperative mediastinitis, a single center experience. INT

Abstract

Introduction Post cardiac surgery mediastinitis is a serious complication, associated with high morbidity and high financial costs. VAC therapy is well established line of treatment in mediastinitis which improves outcome in those patients. Methods Retrospective study to evaluate the outcome of VAC therapy in 34 patients with post-sternotomy mediastinitis. All preoperative, operative and postoperative data are collected and analyzed. Results 34 patients treated with VAC, 27 patients were re-admitted after discharge home, mean time from infection to VAC therapy was 3.34 ± 1.10 days. The duration of VAC therapy was 6.51 ± 1.85 days minimum 3 days and maximum 9 days. The mean amount of discharge was 759.60 ± 175.28 with minimum 354 ml and maximum 990 ml. 21 patients (61.76%) received direct surgical wound closure of the wound, de-wiring or just tighten the sternal wires. 13 patients (41.16%) need debridement of the sternum and re-wiring. 2 patients need bilateral pectoral flap to close the defect of soft tissue. one patient had chronic fistula formation 4 months after discharge home and need de-wiring and curettage of the fistula. One patient had tear in right ventricle controlled surgically. Mean hospital stay 11.28 ± 2.09 days, minimum 6 days and maximum 16 days. One patient died due to postoperative cerebral infarction and multiple organs failure. Conclusion VAC therapy is safe, reliable and cost-effective adjacent to conventional treatment of postoperative mediastinitis especially in high risk patients like old age and diabetics.