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J Thorac Cardiovasc Surg 2004;127:604-605
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

^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.

	References

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1. 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;125:301–305
   
2. Heath BJ, Bagnato VJ. Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage. J Thorac Cardiovasc Surg. 1987;94:355–360
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Luckraz, H. Articles by Ritchie, A. I. Search for Related Content PubMed Articles by Luckraz, H. Articles by Ritchie, A. I. Related Collections Mediastinum Related Article