Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery
Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery
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DOI：
10.1016/j.athoracsur.2005.04.005
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发表时间：
2005-12-01
影响因子：
4.6
通讯作者：
Mahoney, JL
中科院分区：
文献类型：
--
作者：
Cowan, KN;Teague, L;Mahoney, JL
背景胸骨伤口感染是心脏手术引起的严重并发症。最近，通过真空辅助闭合（VAC）疗法对伤口施加负压的一般应用已经显示出增强的肉芽形成和伤口收缩。在这里，我们研究VAC对胸骨伤口的影响。我们收集并统计分析了定量VAC性能数据和结局，并对22例接受VAC治疗的心脏手术后伤口并发症患者进行了回顾性分析。胸骨伤口感染在术后平均21.0天变得明显，与裂开（82%）、胸骨不稳定（59%）、计算机断层扫描积液（73%）和骨髓炎（41%）相关。培养物最常鉴定金黄色葡萄球菌（50%）。对所有患者进行了及时的冲洗和清创，并在诊断后约7.3天进行了VAC治疗。到7天时，胸骨辅助闭合诱导71%的胸骨伤口面积肉芽化，每日引流量约为84 mL。到第14天，伤口尺寸减小了54%，患者在大约19.5天后出院并接受家庭治疗。在约36.7天时停止胸骨辅助闭合，胸骨伤口尺寸平均减小80%。64%的患者避免了需要肌瓣的广泛二次手术闭合，而28%的患者无需手术重建伤口闭合。无与VAC使用相关的并发症。与我们早期的研究相比，连续性VAC治疗显著减少了所需的手术干预、持续性感染的再次手术和住院时间。因此，VAC为治疗胸骨内侧切开术后的术后伤口感染提供了一种可行且有效的预防方法。
Background. Sternal wound infections are a serious complication arising from cardiac surgery. Recently, the general application of negative pressure to wounds by vacuum-assisted closure (VAC) therapy has shown enhanced granulation and wound contraction. Here we examine the effect of VAC on sternal wounds.Methods. We collected and statistically analyzed quantitative VAC performance data and outcomes with a retrospective review on a consecutive cohort of 22 patients treated with VAC for post-cardiac surgery wound complications.Results. Sternal wound infections became evident on average at 21.0 days after surgery, associated with dehiscence (82%), sternal instability (59%), fluid collection by computed tomography (73%), and osteomyelitis (41%). Cultures most commonly identified Staphylococcus auretts (50%). Prompt irrigation and debridement were performed on all patients, and VAC therapy was applied at approximately 7.3 days after diagnosis. Vacuum-assisted closure induced granulation of 71% of the sternal wound area by 7 days, with a daily drainage of approximately 84 mL. By 14 days, there was a 54% reduction in wound size, and patients were discharged after approximately 19.5 days and placed on home therapy. Vacuumassisted closure was discontinued at approximately 36.7 days with an average reduction in sternal wound size of 80%. Extensive secondary surgical closure, requiring muscle flaps, was avoided in 64% of patients, whereas 28% of patients required no surgical reconstruction for wound closure. No complications were related to VAC use.Conclusions. In contrast to our earlier studies, adjunctive VAC therapy markedly reduced required surgical interventions, reoperation for persistent infections, and the hospitalization period. Thus, VAC provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after medial sternotomy.