Use Of Vacuum-assisted Closure Research Articles

Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases.

Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWIafter spine surgery. Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied. First, the persistence of infection when implants were retained or removed was assessed. Second, we analyzed the persistence of infection with respect to the number of I&D, the use of vacuum-assisted closure (VAC) treatment, pseudoarthrosis status, and functional outcomes. One hundred thirty-five patients were included. Treatment of infection with retention of implants occurred in 64% (87/135); of these, 7% (6/87) had a persistent infection. Of patients with implant removal (36%, 48/135), 6% (3/48) had a persistent infection. Thus, we observed no difference between treatment with implants present compared to implants removed (p = 1.0). Fifty of the 135 patients (37%) received I&D and primary wound closure, and 85 (63%) patients received I&D and VACtreatment. There was no statistical difference between primary wound closure and VAC treatment (p = 0.15) with respect to persistence. Repeat I&D with VAC (three or more times) had a significantly lower rate of recurrence than those with two I&Ds. Pseudoarthrosis and persistent infection were unrelated. At minimum one-year follow-up, achieving a minimum clinically important difference in functional outcome was independent of persistent infection status. Persistent infection was unrelated to the retention of implants. When VAC treatment was deemed necessary, more than two I&Ds resulted in a significantly better cure for infection. Those with a persistent infection were no more likely to exhibit pseudoarthrosis than those with no persistent infection. All patients showed improvement in functional outcomes at minimum one-year follow-up.

Use of Vacuum-Assisted Closure to Reduce the Likelihood of Wound Complications After Limb-Sparing Resection of Pediatric Primary Bone Sarcomas of the Femur

BackgroundLimb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial. MethodsPatients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period. ResultsPatients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029). ConclusionsWound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure. Level of EvidenceLevel III Treatment Study.

OPTIMAL APPROACHES FOR LOCAL TREATMENT OF GUNSHOT WOUNDS TO FACILITATE EARLY WOUND HEALING

Gunshot wounds comprise a significant category of injuries resulting from firearm use, involving not only the impact of the blast wave but also damage from metal and secondary tissue fragments. This topic remains highly relevant today, as the appropriateness of local and surgical treatments plays a crucial role in the prompt regeneration of damaged tissues, prevention of purulent complications, swift closure of wound defects, and the optimal restoration of organ function, thereby reducing disability rates for patients.
 This study aims to compare and determine the clinical effectiveness of traditional dressings with antiseptic (Study Group I), hydroactive superabsorbent dressings (Group II), and Vacuum-Assisted Closure (VAC-therapy) (Group III) to provide cleansing of gunshot wounds, prepare the wound surface for skin plastic surgery, prevent secondary necrosis, purulent complications, and ensure the rapid rehabilitation of patients.
 The study included 154 wounded individuals, divided into three groups, with an age range spanning 18 to 50 years. Following our study, it can be inferred that the use of Vacuum-Assisted Closure (VAC-therapy) proves most effective in treating gunshot wounds. This method stimulates the early growth of granulation tissue, with mature granulation tissue evident as early as the 4th day, in contrast to the use of hydroactive dressings (on the 6th day) and traditional gauze material with an antiseptic (on the 7th day). VAC-therapy facilitates marginal epithelization and wound contraction, preventing the development of secondary necrosis and severe purulent complications. Moreover, this approach requires shorter-term antibiotic therapy, exhibits the lowest rate of complications post-repair of a wound defect, and reduces the rehabilitation period for the wounded.

Commentary on: The use of vacuum-assisted closure (VAC) therapy for management of deep sternal wound complications: A systematic review and meta-analysis

Commentary on: The use of vacuum-assisted closure (VAC) therapy for management of deep sternal wound complications: A systematic review and meta-analysis

Use of vacuum-assisted closure in the treatment of complex intrapleural infections

Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure.
 Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression.
 Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p<0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p<0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07).
 Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting.

MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION

You have accessJournal of UrologyCME1 May 2022MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION Ethan Matz, Rahul Dutta, Nicholas Deebel, Justin Refugia, Kim Thai, and Ryan Terlecki Ethan MatzEthan Matz More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Nicholas DeebelNicholas Deebel More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Kim ThaiKim Thai More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Buried penis repair (BPR) is typically performed for morbidly obese men with associated comorbidities. Case complexity is variable and often involves penile split thickness skin grafting (STSG) and use of vacuum-assisted closure (VAC). At our institution, BPR is performed with a multidisciplinary team involving urology and plastic surgery. Collectively, we sought to determine the rate of 30-day complications to determine areas for team-based quality improvement and information relevant to preoperative patient counseling and prehabilitation. METHODS: With IRB approval, all cases of BPR from 2012 to 2021 were reviewed. Data was collected for patient demographics, operative case characteristics, and 30-day complications using the Clavien-Dindo classification. RESULTS: Overall, 63 men underwent BPR for the studied interval. Mean age was 55.9±14.4 years and mean BMI was 41.99±9.17 kg/m2. The rate of overall complications was 33% (21/63). Major complications were seen in 8% of patients, classified as Grade IV (4) and Grade III (1). BMI was an independent predictor of complications (p=0.0257). Additionally, patients noted to have preoperative UTI, even when treated, had significantly higher rates of readmission (p=0.006) and unplanned emergency room (ER) visits (p=0.0006). Baseline hypertension (HTN) was independently associated with ER visits (p=0.0148), but not with overall complications. Presence of home assistance, age, history of CAD or PVD, and preoperative A1c values were not associated with overall complication rate. There was no difference in complications with hospital or home negative pressure wound VAC systems. CONCLUSIONS: Short-term complications following BPR were noted in a third of patients, despite multidisciplinary management. Despite all patients having obesity, BMI was a significant predictor of complications. Patients with a history of preoperative urinary tract infection or HTN also appear to be at increased risk. Quality improvement initiatives targeting monitored preoperative weight loss, urinary assessments with test-of-cure and/or prophylaxis, and more aggressive blood-pressure management will be studied prospectively. Patient counseling will also involve setting expectations on the frequency of complicated recovery. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e325 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz More articles by this author Rahul Dutta More articles by this author Nicholas Deebel More articles by this author Justin Refugia More articles by this author Kim Thai More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF DownloadLoading ...

The utility of incisional vacuum-assisted closure in surgical Management of Hidradenitis Suppurativa: a retrospective cohort study

Wide local excision is the gold standard treatment for severe hidradenitis suppurativa but remains challenging due to high rates of complications and recurrence. Incisional vacuum-assisted closure devices are powerful adjuncts to enhance postoperative wound healing. We performed a retrospective cohort study of all patients who underwent surgical excision for hidradenitis over a 10-year period. The cohort was divided into patients who received standard sterile dressings and those who received incisional vacuum-assisted closure. The primary outcomes were surgical site complications and recurrence of disease. The data were analysed using univariate and multivariable logistic regression analyses. We included 79 patients; patients had multifocal disease which resulted in 220 operative sites. Fifty-eight operative sites (26%) received vacuum-assisted closure and 162 (74%) did not. Operative sites with vacuum-assisted closure were larger (140 vs 60 cm2, p < 0.001) and had longer operations (72 vs 46 min, p < 0.001), and longer hospital stays (6 vs 0 days, p < 0.001). When adjusted for preoperative and operative factors, vacuum-assisted closure did not significantly decrease the odds of experiencing a complication (OR 0.70, p = 0.409) but, however, did significantly reduce the odds of disease recurrence (OR 0.28, p = 0.020). The use of vacuum-assisted closure does not alter risk of complications but may play a role in preventing hidradenitis recurrence. Given the high costs associated with long hospitalisations, more cost-effective solutions should be investigated, such as home vacuum-assisted closure therapy. Level of evidence: Level III, therapeutic study.

The use of vacuum-assisted closure in Fournier’s gangrene

Objectives: Fournier’s gangrene is an emergency surgical disease which develops and progresses rapidly and there is high risk of mortality with a delay in diagnosis and treatment. The objective of this study is to investigate the impact of vacuum-assisted closure on the clinical outcome in the treatment of Fournier’s gangrene. Methods: A total of 28 patients diagnosed as Fournier’s gangrene and admitted to our hospital from January 2010 to December 2018 are included in this retrospective study. The diagnosis was established on the basis of physical examination. Epidemiological data including gender, age, and presence of diabetes mellitus, clinical outcomes including use of vacuum-assisted closure, length of admittance, the number of debridement and other surgical procedures were evaluated retrospectively from the medical records and the hospital treatment registry. Results: There were 16 (57.1%) male and 12 (42.9%) female patients and the mean age of the patients was 59.54 ± 16.76 years. The mean number of debridement was 3.67 ± 1.5 times and the total hospital stay was 26.67 ± 7.7 days for vacuum-assisted closure group (n = 9). The average number of debridement was 4.11 ± 0.94 times and the total hospital stay was 31.58 ± 6.33 days for the rest of the patients (n = 19). Conclusions: The average number of debridement and hospital stay were lower in patients treated with vacuum-assisted closure. We also observed an increase in patient comfort and the workload of the stuff is decreased as there was less exudate in the vacuum-assisted closure group.

Vacuum-Assisted Closure in a Patient With Entero-Atmospheric Fistula: A Case Report

The entero-atmospheric fistula (EAF) is a recognized complication of open abdomen surgeries, which causes significant morbidity and mortality. This usually causes long hospitalizations and may require many surgical operations. While different methods of treatment for EAF are used, all different methods share the same goal, which is a proper closure of the fistula and the open abdomen to avoid recurrence and complications. We report a case of a 48-year-old female with a bowel perforation following an attempted open bilateral ovarian cyst drainage with cyst wall biopsy complicated by entero-atmospheric fistula treated by wound closure with vacuum-assisted pressure. In conclusion, the use of vacuum-assisted closure (VAC) to induce spontaneous healing of EAFs can provide a safe acceptable alternative to surgical treatment.

Reverse Sural Artery Flap for Dorsum of Foot Reconstruction

Loss of skin over the dorsum of foot is a common clinical entity. Infection, trauma, and vascular disease represent the most common etiological factors. Salvage of foot in these cases has a bearing upon the quality of life of the patient. The reconstruction process is often complex and varied as per exigencies. Reverse sural artery flap is an easy and reliable option for reconstruction of dorsum of foot defect. Reverse sural artery draws its vascularity from the communication of the peroneal artery and the median sural artery. The flow of the flap is from the distal to the proximal and represents an elegant option for dorsum of foot. We have described the peninsular variant of the reverse sural artery. The coverage of the defects of the dorsum of foot in trauma can be performed either immediately if the wound conditions are favorable or we may have to delay the procedure of definitive cover by a few days till the wound conditions improve by use of vacuum-assisted closure (VAC) application. Split thickness graft, reverse sural artery flap, and free flaps provide safe and viable options for dorsum of foot defects. Reverse sural artery is reliable option in the armamentarium of the reconstructive surgeon. Gaba S, Sharma RK, John JR, et al. Reverse Sural Artery Flap for Dorsum of Foot Reconstruction. J Foot Ankle Surg (Asia Pacific) 2021;8(1):28–32.

Alleviating the Need for Free Flap Transfer through the Exemplary Use of Vacuum-Assisted Closure

Alleviating the Need for Free Flap Transfer through the Exemplary Use of Vacuum-Assisted Closure

The use of vacuum-assisted closure in spinal wound infections with or without exposed dura.

The treatment of postoperative deep spinal wound infection involves debridement and intravenous antibiotics. Authors have previously reported success in a small series of patients treated with vacuum-assisted closure (VAC) therapy, but its use over exposed dura is controversial and the outcome has not been reported in large series. To review the outcomes following the treatment of postoperative spinal infections with VAC therapy, particularly those with exposed dura. This is a review of prospectively collected data in 42 patients, all of whom had deep postoperative spinal infections. 30 of these patients had exposed dura. All patients had an initial debridement followed by application of VAC Whitefoam (with exposed dura) or grey Granufoam (where no dura was exposed). Pressure was set at 50mmHg with exposed dura or 125mmHg where no dura was exposed. All patients underwent a minimum 6week course of antibiotics. We report on the number of visits to theatre required for dressing changes and debridement and the eventual outcomes. Five patients required a flap reconstruction. Two patients died before definitive final closure due to other complications (pneumonia and stroke). In all the other patients, their wounds healed fully. A mean of 2.3 infection surgeries were required to eradicate infection and achieve wound closure. This is one of the largest studies which confirms the safety and efficacy of VAC dressings in patients with spinal wound infections, even when the dura is exposed. These slides can be retrieved under Electronic Supplementary Material.

Use of Vacuum-Assisted Closure in the Management of Colostomy

Background: This article is the first report of the simultaneous use of vacuum-assisted closure (VAC) therapy and an oral tube applied as a life-saving treatment for colostomy dehiscence to avoid fecal contamination. Case Presentation: A 75-year-old female was admitted to our surgical unit in 2012 for knee trauma caused by an accidental fall at home. Surgery for lysis of adhesions, left colectomy, colorectal anastomosis, and protective ileostomy was performed initially for sigmoidovaginal fistula. Vacuum-assisted closure therapy (applying continuous negative abdominal pressure) was used after median wound dehiscence and a parastomal abscess that caused the necrosis of the skin and subcutaneous tissue surrounding the colostomy. Conclusion: The application of a negative pressure is a novel approach to colostomy dehiscence and complicated abdominal wound management and can lead to complete abdominal wound closure and finally to apply a standard plate for colostomy bag.

Evaluation of the use of vacuum-assisted closure (VAC) and platelet-rich plasma gel (PRP) in management of complex wounds

Background “Complex wounds” is a term used to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. To compare the healing of complex wounds using vacuum-assisted closure (VAC) and platelet-rich plasma (PRP).

The Use of Vacuum-Assisted Closure and GranuFoam Silver® Dressing in the Management of Diabetic Foot Ulcer.

The aim of this retrospective study was to evaluate the efficacy of vacuum-assisted closure (VAC) and GranuFoam Silver® dressing (KCI, San Antonio, TX) compared with conventional GranuFoam® dressing in the management of diabetic foot ulcers. Twenty-one consecutive patients treated with conventional or silver-coated foam dressing were reviewed retrospectively. The wound duration was 6 mo. Group 1 (n=10) received conventional foam dressing (GranuFoam) and group 2 (n=11) received silver-coated foam dressing (GranuFoam Silver). The wound surface area, duration of treatment, bacteriology, and recurrence were compared between the groups. The mean age of the patients was 61.70±10.52 y in group 1 and 67.27±11.28 y in group 2. In group 1, the average surface area of the wounds was 45.30±46.96 cm2 and 18.40±23.48 cm2 in the pre-treatment and post-treatment periods, respectively. There was a statistically significant difference between two measurements (p=0.005). Average duration of the treatment was 25.50±27.13 d in this group. In group 2, average surface area of the wounds in the pre-treatment and post-treatment periods were 41.55±36.03 cm2 and 7.64±3.91 cm2, respectively. There was a statistically significant difference between two measurements (p=0.003). Average duration of the treatment was 10.09±3.51 d in this group. The patients treated with silver-impregnated polyurethane foam dressing had reduced recurrence (2 vs. 7 wounds, p=0.030) and increased number of the culture-negative cases at the end of the treatment. With the results of the study, it was concluded that VAC GranuFoam silver dressing can be superior to conventional GranuFoam dressing in reducing the recurrence rate of infected diabetic foot ulcers.

The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications in extremity soft tissue sarcoma.

The aim of this study was to determine the relationship of the time interval between completion of preoperative radiation therapy (RT) and surgical resection on wound complications (WCs) in extremity soft tissue sarcoma (STS). Overall, 798 extremity STS patients were managed with preoperative RT and surgery from 1989 to 2013. WCs were defined as requiring secondary operations/invasive procedures for wound care, use of vacuum-assisted closure, prolonged dressing changes, or infection within 120 days of surgery. Mean tumor size was 8.8 cm. A total of 743 (93 %) tumors were primary presentations, 565 (71 %) patients had lower extremity tumors, and 238 patients (30 %) had a prior unplanned excision. Of 242 patients (30 %) who developed a WC, 206 (37 %) had lower extremity tumors and 36 (15 %) had upper extremity tumors. Mean time from RT completion to surgery was 41.3 (range 4-470) days; 42.0 (range 4-470) days for upper extremity cases, and 41.1 (range 4-109) days for lower extremity cases. Similarly, mean time interval for patients who developed a WC was 40.9 (range 4-100) days, and 41.5 (range 4-470) days for those who did not develop a WC (p = 0.69). Thirty-nine cases (5 %) had surgery within 3 weeks of RT; 15 (38 %) patients developed WCs versus 227 (30 %) patients who had their tumors excised after 3 weeks (p = 0.28). One hundred and twenty-nine (16 %) patients had surgery within 4 weeks, and 39 (30 %) patients developed WCs versus 203 (30 %) patients who had their tumors excised after 4 weeks (p = 1.0). A trend towards a higher rate of WCs was seen for those patients who had surgery after 6 weeks (28 % prior vs. 34 % after; p = 0.08). There was no difference in WCs with intensity-modulated RT (IMRT) versus non-IMRT cases (p = 0.6). The time interval between preoperative RT and surgical excision in extremity STS had minimal influence on the development of WCs. Four- or 5-week intervals showed equivalent complication rates between the two groups, suggesting an optimal interval to reduce potential WCs.

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

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.

Negative Pressure Wound Therapy in the Management of Late Deep Infections After Open Reconstruction of Achilles Tendon Rupture

Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.

Postoperative Local Morbidity and the Use of Vacuum-Assisted Closure After Complex Chest Wall Reconstructions With New and Conventional Materials

New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p=0.038) and second (p=0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p=0.049) undergoing one (p=0.032) or two reconstructions (p=0.00047) with combined materials (p=0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p=0.032; second, p=0.00047) and the use of combined (synthetic and biologic) materials (p=0.0029) were confirmed to be related to an increased incidence of wound complications. Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.

Mediastinitis after cardiac procedures via median sternotomy: comparative analysis of outcomes

Aim. To compare the effectiveness of poststernotomy mediastinitis treatment in 41 patients who underwent vacuum-assisted closure or closed irrigation treatment. Methods. A retrospective analysis of 41 cases of sternal wound infection identified in patients who underwent cardiac surgery between 2007 and 2012. 18 patients (the first group) were treated using closed irrigation, 23 patients (the second group) - using vacuum-assisted closure. We compared the time interval for wound healing and drainage, serum levels of C-reactive protein and blood leukocyte counts on admission and at different time points until discharge. Results. In patients who were treated using vacuum-assisted closure, wound debridement and healing were achieved at shorter terms, and lower rate of complications were observed. There were 8 (44.4%) relapses requiring repeated surgery and debridement in the first group compared to 3 (13%, p=0.01) in the second group. C-reactive protein level decreased more rapidly in patients who were treated using vacuum-assisted closure (p 0.02). The duration of hospital stay was 67±4.1 days in the first group compared to 29.6±8.4 days in the second group (p=0.019). Moreover, patients who were treated using vacuum-assisted closure did not experience any significant discomfort and stayed active. Histological examination of the soft tissues showed marked lymphoid and plasma-cell reaction and neoangiogenesis by the end of the second week of vacuum-assisted closure. Conclusion. The use of vacuum-assisted closure shortens the term of wound debridement, granulating tissue formation and the duration of hospital stay compared to closed irrigation treatment.