Clinical outcome using the vacuum-assisted closure system 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 non-invasive therapy based on the application of negative pressure by controlled suction to the wound surface. The aim of this work was to evaluate the clinical outcome in patients to whom we applied the VAC system in terms of wound healing, duration of treatment, and complications related to the procedure in addition to early follow-up. Methods: 15 patients [7 men, 8 women] with a mean age of 69.3 years who presented with sternal wound complications [infection / dehiscence] after coronary artery bypass surgery were managed using the VAC system after surgical debridement. The VAC therapy was used either as definitive treatment till healing was achieved by secondary intention or followed by flap reconstruction [muscle or omental], skin graft or delayed sternal rewiring. Patients were followed up for a mean period of 14 months as regards recurrence of infection, wound healing and fistula formation. Healing was successful in all patients. 3 patients had pectoralis major muscle flap reconstruction, the wound was covered by an omental flap in one patient, 2 patients had only a skin graft to cover the defect, healing by secondary intention was achieved in 5 patients, and delayed sternal rewiring was performed in another 4 patients. Follow-up for a mean of 14 months [range 7 months - 26 months] showed complete healing in all surviving patients without recurrence of infection or fistula formation with one mortality due to multi-organ failure 6 months after presentation with mediastinitis. VAC system is an effective and safe device in managing patients with complicated sternal wounds providing wound control so that reconstructive surgery can be electively planned, 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. Outcomes are encouraging with excellent results: