The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery
The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery
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DOI：
10.1016/s0003-4975(02)03948-6
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发表时间：
2002-11-01
影响因子：
4.6
通讯作者：
Grabenwoger, M
中科院分区：
文献类型：
--
作者：
Fleck, TM;Fleck, M;Grabenwoger, M
背景VAC系统（真空辅助伤口闭合）是一种非侵入性主动疗法，用于促进对既定治疗模式无反应的困难伤口的愈合。该系统基于通过对伤口表面进行受控抽吸来施加负压。该方法于1996年引入临床实践。此后，大量研究证明了VAC系统对微循环和促进肉芽组织增殖的有效性。11例心脏手术后胸骨伤口感染的患者（5例男性，6例女性），中位年龄为64.4岁（范围50 - 78岁）（冠状动脉旁路移植术= 5例，主动脉瓣置换术= 5例，升主动脉置换术= 1例），在初次手术清创时安装了VAC系统。所有患者均达到完全愈合。平均9.3天（范围4 - 15天）后，当全身感染体征消退且定量培养为阴性时，取出VAC系统。在6名患者（54.5%）中，VAC系统被用作胸大肌瓣重建手术的桥梁，在其余5名患者（45.5%）中，可以实现一期伤口闭合。重症监护室住院时间为1至4天（中位数为1天）。住院时间从13天到45天不等（中位数30天）。住院死亡率为0%，30天生存率为100%。结论。VAC系统可被视为心脏手术后胸骨伤口感染治疗的传统和既定治疗模式的有效和安全辅助手段。(C)2002年由胸外科医师协会出版。
Background. The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation.Methods. Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement.Results. Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%.Conclusions. The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery. (C) 2002 by The Society of Thoracic Surgeons.