Role of Vacuum Assisted Closure (VAC) System in Management of Sternal Wound Infection Post-cardiac Surgery

Abstract

SUMMARY T he midline sternotomy advocated by Julian in 1957 allowed the surgeons excellent access to mediastinal structures. The sternal split will continue to give the necessary exposure for combined procedures including valve replacement, great vessel replacement, and transplants. Disruption and infection of median sternotomy wounds are grave complications, occurring in 3.5% - 5% as an average of many literature,superficial wound infections occur in approximately 4% of patients following cardiac operations, in 1% of patients the infection involves the mediastinum. Infection of the mediastinum space after open heart surgery although infrequent,is serious and potentially fatal complication. Vacuum-assisted closure combines several advantageous features in treatment of sternal wound infections . During the last years VAC therapy has been adopted for use in poststernotomy wound infection and mediastinitis and the use of this wound healing therapy is currently spreading throughout the cardiothoracic surgeries. The VAC system can be used efficiently as aprimary treatment modality for sternal wound infection or as abridge for conventional methods. VAC system seems to significantly reduce the risk of early re-infections, increase the rate of granulation tissue formation,decrease the tissue edema, stabilize the sternal haves, with excellent survival and low failure rate with reduction of the length and cost of hospital stay.