Vacuum-assisted closure as a treatment modality for sternal wound complications after coronary artery bypass surgery

ABSTRACT

Sternal infections after median sternotomy remain a serious cause of postoperative morbidity and mortality. There is still no consensus regarding the ideal treatment of this complication. The vacuum-assisted closure [VAC] system is a noninvasive therapy based on the application of negative pressure by controlled suction to the wound surface. This method has been proven to be effective in the promotion of granulation tissue proliferation. 7 patients [3 men, 4 women] with a mean age of 68.4 years who presented with sternal wound complications [infection / dehiscence] after coronary artery bypass surgery were managed using the VAC system after surgical debridement. The system was used either as a temporary wound care technique prior to muscle flap closure, or covered by a skin graft, or till healing is achieved by secondary intention. Healing was successful in all patients. 3 patients had pectorals major muscle flap reconstruction, 2 patients had a skin graft to cover the defect and the wound was left for healing by secondary intention in 2 patients. VAC system is an effective and safe device in managing patients with complicated sternal wounds pro viding wound control so that reconstructive surgery can be electively planed, or may obviate the need for a second closure operation by allowing the wound to contract and rapidly granulate in addition to its stabilizing effect allowing early extubation and mobilization of the patient