Use of VAC therapy and sternal plating in the treatment of sternotomy wound dehiscence

Abstract

Sternal dehiscence has a high morbidity and mortality. Many treatment modalities have evolved. Early wound management and closure has a positive outcome. Vacuum-assisted closure (VAC) therapy has proven to be effective, and recently the closure of the sternum with internal plate fixation appears to be beneficial. We present a small series with their combined usage. We retrospectively reviewed eight cases of sternal wound dehiscence or sepsis referred to our unit for further management for the period January 2006 to December 2007. The subjects consisted of five males and three females with their ages ranging from 47 to 74 years (mean = 63 years). All patients had a premorbid history of hypertension and hyperlipidemia and five of diabetes. The patients were managed with a combination of serial debridement, VAC therapy, and sternal internal plate fixation and bilateral pectoralis major advancement flap. In three patients, final closure was obtained after sternal plating. Two patients achieved final closure by VAC therapy only. Three patients died of multiple-organ failure while undergoing wound bed preparation. We believe the use of VAC therapy and definitive wound closure using sternal plating, as part of a staged treatment, is an effective method for managing sternotomy wound dehiscence.