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J Thorac Cardiovasc Surg 2003;125:301-305
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Vacuum-assisted closure as a treatment modality for infections after cardiac surgery

From the Cardiothoracic Surgical Unit, Papworth Hospital, Papworth, Everard,^a and MRC Biostatistics Unit, Cambridge,^b United Kingdom.

Received for publication Dec 18, 2001. Revisions requested Feb 18, 2002; revisions received March 20, 2002. Accepted for publication March 29, 2002. Address for reprints: Heyman Luckraz, FRCS, Cardiothoracic Specialist Registrar Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, United Kingdom (E-mail: HeymanLuckraz{at}aol.com).

Objective: Wound infections after cardiac surgery carry high morbidity and mortality. A plethora of management strategies have been used to treat such infections. We assessed the impact of vacuum-assisted closure on the management of sternal wound infections in terms of wound healing, duration of vacuum-assisted closure, and cost of treatment.
Methods: Between November 1998 and June 2001, a total of 27 mediastinal infections were managed with vacuum-assisted closure. Group A (n = 14) had vacuum-assisted closure as the final treatment modality, whereas in group B (n = 13) vacuum-assisted closure was followed by either a myocutaneous flap (n = 8) or primary (n = 5) wound closure. The choice of additional treatment modality was based on wound size.
Results: In group A, 4 patients died and a satisfactorily healed scar was achieved in 64% of cases. Median durations of vacuum-assisted closure and hospital stay in group A were 13.5 days (interquartile range 8.8-32.2 days) and 20 days (interquartile range 16.7-25.2 days), respectively. Mortality was 7.7% in group B, with a treatment failure rate of 15%. Median duration of vacuum-assisted closure in group B was 8 days (interquartile range 5.5-18 days), and median hospital stay was 29 days (interquartile range 25.8-38.2 days). During the year before institution of vacuum-assisted closure, poststernotomy infection (n = 13) was managed with rewiring and closed irrigation system. Treatment during this year failed in 30.7% of cases (n = 4/13), and mortality was also 30.7%. The total cost (hospitalization and treatment) per patient for vacuum-assisted closure was $16,400, compared with $20,000 for the closed irrigation system treatment.
Conclusion: Vacuum-assisted closure, used alone or before other surgical treatment strategies, is an acceptable treatment modality for infections in cardiac surgery with reasonable morbidity, mortality, and cost.

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