RESUMO
Evaluate the endothelium histological changes produced in the left internal mammary artery (LIMA) after its dissection in a skeletonized manner with an ultrasonic scalpel. Two study groups were created in a prospective and randomized way: group A, 14 LIMA fragments skeletonized with a high frequency ultrasonic scalpel and group B (control group) with 14 specimens dissected with scissors and clips. The endothelium was studied in all 28 fragments fixing the segments with 10% formaldehyde, and paraffin inclusion. The arteries were sliced in 4 microm sections and stained with hematoxilin-eosin, and then evaluated by one single pathologist. In group A (ultrasonic scalpel) none of the specimens showed any endothelial damage, as did the samples in group B (control group). In both groups the endothelial wall was intact. There were chronic lesions in the form of intimal hyperplasia that might be in relation to the advanced age of both groups of patients. The left IMA dissection in a skeletonized fashion with an ultrasonic scalpel does not produce endothelial structural damage in it being similar to the one dissected with conventional methods. This permits its safe use, allowing us to benefit from the numerous advantages of arterial grafts usage in modern era coronary surgery.
RESUMO
The VAC (vacuum-assisted closure) system is a non-invasive therapy based on the application of negative pressure by controlled suction to the wound surface. This method has been proved to be effective on the promotion of granulation tissue proliferation. The aim of the study was to evaluate the effectiveness of the vacuum-assisted therapy with a handcrafted system, because the commercialized one was not available in our institution. Since July 2004, seven patients with sternal wound infection after median sternotomy were treated with vacuum-assisted therapy. All patients underwent surgical debridement under aseptic conditions. Thereafter, the patients received vacuum-assisted therapy with a handcrafted system. Complete healing with a tension-free wound direct closure was achieved in all patients, without morbidity. Removal of the system was done after a median of 15 days after surgery (range 8-47 days). All patients received intravenous antibiotics during the treatment. The cultures became negative after a median of 7 days (range 2-21 days). We suggest that our method, based on the negative pressure principle, is a valuable and effective tool in the management of patients with wound infection after median sternotomy when the commercialized one is not available.
