In the last decade a new and more effective method--the vacuum assisted
wound closure (VAC)--was introduced for the treatment of the mediastinal
wound infections following open heart operations. This technique gained a widespread acceptance in many countries of the world. The Centre of Cardiac Surgery of the University of Debrecen was the first to apply this treatment in Hungary. The authors evaluated the VAC
therapy in a retrospective study at their institute. Between September 2002 and December 2005 62 consecutive patients were treated with this method because of
wound infection in
median sternotomy. Median age of 42 males and 20 females was 63,1 +/- 6,8 years (42-75). All patients had heart surgery (cardio pulmonary bypass) before they developed superficial or deep
wound infection in their
sternotomy site. Following exploration and radical
debridement of the
sternotomy wounds, VAC method was used for the treatment of infected
wounds until
suppuration stopped. When the
wound had become macroscopically clear, reconstruction of the sternal defect was performed. This was carried out with well vascularized soft tissue flap(s) (major pectoral muscle and/or omental or pericardial fat pad) in 34 patients, sternal refixation was performed in 13 cases, while 11 patients underwent delayed secondary
wound reconstruction with
sutures. In one case Ley-
prosthesis (sternal stabilisator
metal prosthesis) was implanted. Three patients died before the sternal
wound reconstruction. As a result of VAC
therapy, all infected mediastinal
wound cleaned up rapidly and formation of granulation tissue began. The mean period of time from the first sign of the
infection to hospital discharge of the patients was 42.2 +/- 18.5 (5-185) days, while the same between sternal reconstruction and discharge was 19.9 +/- 9.6 (1-63) days. The mean duration of VAC
therapy was 7.9 +/- 3.4 (1-21) days. The hospital mortality was 11.3% (7/62). Recurrence of the
infection occurred in two patients (3.6%). These results suggest that
Vacuum-assisted Closure system is an effective and safe method for the treatment of
sternotomy wound infections following cardiac surgery. This method facilitates early clean up of infected
sternotomy wounds and decreases the recurrence rate significantly.