ABSTRACT
We employed vacuum-assisted closure (VAC) as a treatment modality for wound complications after cardiovasular surgery. Between March and December 2004, 9 patients were treated with VAC, 8 of whom were men, and the mean age was 69.6 years old. Seven patients underwent off-pump coronary artery bypass, and 2 underwent a valve replacement. Six of them had diabetes, 5 had renal dysfunction (4 were dialysis patients), and 2 had chronic obstructive lung disease. Six cases were classified as superficial sternal infection (Superficial) and 3 as a deep sternal infection (Deep). Superficial cases were healed with wound closure after a short period of VAC treatment. However, Deep cases required long duration of VAC treatment and wound closure with a myocutaneous flap in 2 cases, although all of them did not develop mediastinitis requiring closed irrigation and drainage. In 9 cases, with numerous risk factors for poor healing, we found that VAC treatment facilitated wound healing and reduced frequent painful wound care.
ABSTRACT
A 59-year-old man underwent an aorto-bifemoral bypass operation for aorto-iliac arteriosclerotic occlusive disease. The total aortic occlusion time was 38min. Soon after the operation, the patient was found to have motor and sensory loss between right L<sub>2</sub> and S<sub>1</sub>, which did not improve. We considered that spinal cord damage was caused by occlusion of the lumbar artery as a result of side clamping of the atherosclerotic abdominal aorta. Therefore, side clamping of the atherosclerotic aorta should be avoided to prevent this serious complication.
ABSTRACT
CPK-MM, one of the CPK-isozyme, is divided into the three subbands (isoform) MMa, MMb, MMc. It has reported that in acute myocardial infarction serum MMa and MMa/MMc increased earlier than other myocardial intracellular enzyme, such as CPK-MB. In this study, we measured serum CPK, CPK isozyme, and CPK isoforms during and after open heart surgery and examined whether CPK isoforms would serve as a marker for myocardial damage during open heart surgery. CPK-MB peaked at 153.3±85.1IU six hours after cardiopulmonary bypass (CPB) was taken off and subsequently decreased. On the other hand, MMa/MMc peaked at 5.6±2.2 immediately after CPB was taken off. Moreover, we found that there was a statistically significant positive correlation (<i>Y</i>=24.46<i>X</i>+16.68, <i>r</i>=0.63, <i>p</i><0.05) between MMa/MMc immediately after CPB was taken off and CPK-MB six hours after CPB was taken off. The maximum value of CPK-MB correlates with the degree of myocardial damage. Therfore, it is reasonable to suggest that the maximum value of MMa/MMc immediately after CPB is taken off also correlates with the degree of myocardial damage. We concluded that serum CPK isoform, especially MMa/MMc served as a marker to estimates the degree of myocardial damage in open heart surgery at an early stage.