J Thorac Cardiovasc Surg 2004;127:604-605
© 2004 The American Association for Thoracic Surgery
Reply to the Editor
H. Luckraz, FRCSa,
A. I. Ritchie, FRCSa
a Papworth Hospital, Cambridge, United Kingdom
We note the comments of Aru and Call. Our article1 described our initial experience with vacuum-assisted closure (VAC) for treating sternal wound infection. It was a purely descriptive rather than comparative process, and hence the results should be interpreted likewise. The number of patients described was relatively small (27 patients), and sweeping conclusions may be misleading. However, in the population group that we described, VAC represented an acceptable treatment option relative to our previous experience. We are currently running a randomized study that will include a larger number of patients and will compare VAC with other treatment modalities.
With respect to their queries about wound débridement in group A, 14 had wound débridement, among whom 3 died (2 patients with methicillin-resistant Staphylococcus aureus sepsis and multiorgan failure and 1 patient with pneumonia). There was a further death in group A of a patient who did not have wound débridement, and the cause of death was peritonitis. In group B 10 patients underwent wound débridement, 1 of whom died. The 3 group B patients who did not have the wound débrided all survived. Moreover, the incidence of mediastinitis was described as a ratio, not a percentage, of 0.05 (27/491), which is equivalent to the 5% that they calculated.
We are delighted to see Aru and Call support the use of VAC in their letter, although their criteria differ from ours. However, they seem convinced that the main treatment modality for mediastinitis involves the use of an omental flap. We would be grateful if they could share their up-to-date experience, rather than the 1987 data,1 with us.
- Luckraz H, Murphy F, Bryant S, Charman SC, Ritchie AJ. Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. J Thorac Cardiovasc Surg. 2003;125:301305
- Heath BJ, Bagnato VJ. Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage. J Thorac Cardiovasc Surg. 1987;94:355360
Limitations on the role of vacuum-assisted closure in cardiac surgery
- Giorgio M. Aru and Kenneth D. Call
J. Thorac. Cardiovasc. Surg. 2004 127: 604.