Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
Impact Factor (IF) – 1.227
Index Copernicus (ICV 2018) – 157.72
MNiSW – 40
Average rejection rate – 84.38%
ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download PDF

Advances in Clinical and Experimental Medicine

2015, vol. 24, nr 4, July-August, p. 643–650

doi: 10.17219/acem/28111

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

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

Mariusz J. Listewnik1,A,B,C,D,E,F, Piotr Sielicki1,A,B,D,E, Krzysztof Mokrzycki1,D,E, Andrzej Biskupski1,C,E, Mirosław Brykczyński1,A,C,D,E,F

1 Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland

Abstract

Background. Sternal wound infections are a serious and potentially fatal complication of cardiac surgery.
Objectives. The aim of the study was to analyze the results of using the vacuum-assisted closure (VAC) system over a 4-year period.
Material and Methods. Quantitative VAC performance data from a retrospective review of a consecutive cohort of 47 patients treated with VAC for post-cardiac surgery wound complications were collected and statistically analyzed. In the study group 35 patients 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.
Results. The statistical analysis identified the following as significant risk factors: age, female sex, being overweight, a high 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.
Conclusion. The use of negative-pressure wound therapy with other concomitant surgical procedures is a good 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.

Key words

cardiac surgery, vacuum assisted therapy, wound infection.

References (15)

  1. Cowan KN, Teague L, Sue SC, Mahoney IL: Vacuum-Assisted Wound Closure of Deep Sternal Infections in High-Risk Patients After Cardiac Surgery. Ann Thorac Surg 2005, 80, 2205–2212.
  2. Hosseinrezaei H, Rafiei H, Amiri M: Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery. J Wound Care 2012, 21, 408–411.
  3. Zeitani J, Bertoldo F, Bassano C, Penta de Peppo A, Pellegrino A, El Fakhri FM, Chiariello L: Superficial wound dehiscence after median sternotomy: surgical treatment versus secondary wound healing. Ann Thorac Surg 2004, 77, 672–675.
  4. Steingrimsson S, Gottfredsson M, Gudmundsdotti I, Sjögren J, Gudbjartsson: Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections. ICVTS 2012, 15, 406–410.
  5. Argenta LC, Morykwas MJ: Vacuum assisted closure. A new method for wound control and treatment: clinical experience. Ann Plast Surg 1997, 38, 563–577.
  6. Borowiec JW: Infekcje rany dostępu chirurgicznego w kardiochirurgii ¨C „Wizja Zero”. Kardiochir Torakochir Polska 2010, 7, 383–387.
  7. Abboud CS, MD, Wey SB, Baltar VT: Risk Factors for Mediastinitis After Cardiac Surgery. Ann Thorac Surg 2004, 77, 676–683.
  8. Diez C, Koch D, Kuss O, Silber R-E, Friedrich I, Boergermann J: Risk factors for mediastinitis after cardiac surgery ¨C a retrospective analysis of 1700 patients. JCTS 2007, 2, 23–30.
  9. Fowler Jr. VG, O’Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED: Clinical Predictors of Major Infections After Cardiac Surgery. Circulation 2005, 112, 358–365.
  10. Deniz H, Gokaslan G, Arslanoglu Y, Ozcaliskan O, Guzel G, Yasim A, Ustunsoy H: Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus cenventional treatment. J Cardiothorac Surg 2012, 7, 67–73.
  11. Chaudhuri A, Shekar K, Coulter C: Post-operative deep sternal wound infections: making an early microbiological diagnosis. Eur J Cardiothorac Surg 2012, 41, 1304–1308.
  12. Gårdlund B, Bitkover CY, Vaage J: Postoperative mediastinitis in cardiac surgery microbiology and pathogenesis. Eur J Cardiothorac Surg 2002, 21, 825–830.
  13. Garey KW, Kumar N, Dao T, Tam VH, Gentry LO: Risk factors for postoperative chest wound infections due to gram-negative bacteria in cardiac surgery patients. J Chemother 2006, 18, 402–408.
  14. Ottino G, De Paulis R, Pansini S, Rocca G, Tallone MV, Comoglio C, Costa P, Orzan F, Morea M: Major Sternal Wound Infection after Open-Heart Surgery: A Multivariate Analysis of Risk Factors in 2,579 Consecutive Operative Procedures. Ann Thorac Surg 1987, 44, 173–179.
  15. De Brabandere K, Jacobs-Tulleneers-Thevissen D, Czapla J, La Meir M, Delvaux G, Wellens F: NegativePressure Wound Therapy and Laparoscopic Omentoplasty for Deep Sternal Wound Infections after Median Sternotomy. Tex Heart Inst J 2012, 39, 367–371.