Managing deep sternal wound infections with vacuum-assisted closure

Deep sternal wound infection is an uncommon but serious complication of cardiac surgery. Currently, there is no consensus on the optimal management. Vacuum-assisted closure (VAC) has been increasingly used to facilitate wound healing. We aim to review the management of deep sternal wound infections using VAC dressing at our hospital. A retrospective review of consecutive cases of deep sternal wound infections was carried out. Median sternotomies were carried out in 2665 patients between July 2001 and June 2006. Thirty-one patients developed deep sternal wound infections (1.2%). In 26 of these patients, VAC dressing was used either as a stand-alone therapy or as an adjunct to late sternal reconstruction. Deep sternal wound infections were diagnosed on average 13 days from initial surgery. Of the patients treated with VAC dressing, 17 (65%) had stand-alone VAC therapy and 9 had VAC therapy followed by sternal reconstruction. The average duration of VAC dressing in the two groups were 21 and 13 days respectively. There were seven in-hospital deaths, six in the stand-alone VAC group and one death from a reconstructive patient who did not have VAC therapy. The length of hospital stay was similar in two VAC groups (37 vs 45 days). Median follow up was 17 months. No late relapse was found in the stand-alone group. In the intermediate therapy group, two patients had chronic wound sinuses and one patient had a wound collection. Vacuum-assisted closure dressing may be used both as a stand-alone and as an intermediate therapy for deep sternal wound infection. Reconstructive surgery may be avoided in a significant proportion of patients. No late relapse has been associated with VAC use.