PMID- 19216084
OWN - NLM
STAT- MEDLINE
DCOM- 20091109
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 35
IP  - 5
DP  - 2009 May
TI  - Improved results of the vacuum assisted closure and Nitinol clips sternal closure 
      after postoperative deep sternal wound infection.
PG  - 833-8
LID - 10.1016/j.ejcts.2008.12.036 [doi]
AB  - OBJECTIVE: Postoperative deep sternal wound infection is a severe complication of 
      cardiac surgery, with a high mortality rate and a high morbidity rate. The 
      objective of this prospective study is to report our experience with the vacuum 
      assisted closure (VAC) system for the management of deep wound infection. We also 
      devised an innovative closure technique post VAC therapy using thermo reactive 
      clips. The advantage of this technique is that the posterior face of the sternum 
      does not have to be separated from the mediastinal structures thus minimising the 
      risk of damage. METHODS: From October 2006 to October 2008, we prospectively 
      evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen 
      patients had sternotomy for coronary artery bypass grafting (CABG), one patient 
      for aortic valve replacement (AVR) and another one for ascending aortic 
      replacement (AAR). All patients were treated with the VAC system at the time of 
      infection diagnosis. When the wound tissue appeared viable and the 
      microbiological cultures were negative, the chest was closed using the most 
      suitable procedure for the patient in question; nine patients were closed using 
      pectoralis flaps, nine patients using Nitinol clips, one patient with a combined 
      technique (use of Nitinol clips and muscle flap), one patient with a direct wound 
      closure and another patient, who needed AAR with a homograft performed in another 
      institution, was closed using sternal wires. RESULTS: We had no mortality; wound 
      healing was successfully achieved in all patients. In more than 50% of the 
      patients, the VAC therapy allowed direct sternal resynthesis. The average 
      duration of the vacuum therapy was 26 days (range 14-37 days). CONCLUSIONS: VAC 
      is a safe and effective option in the treatment of post-sternotomy mediastinitis, 
      with excellent survival and immediate improvement of local wound conditions; 
      furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe 
      and non-invasive option for sternal resynthesis. After VAC therapy, a reduction 
      in number of muscular flaps used and an increase of direct sternal resynthesis 
      were observed.
FAU - Tocco, Maria Pia
AU  - Tocco MP
AD  - Thoracic Surgery Unit, S Filippo Neri Hospital, Rome, Italy. mptocco@yahoo.it
FAU - Costantino, Alberto
AU  - Costantino A
FAU - Ballardini, Milva
AU  - Ballardini M
FAU - D'Andrea, Claudio
AU  - D'Andrea C
FAU - Masala, Marcello
AU  - Masala M
FAU - Merico, Eusebio
AU  - Merico E
FAU - Mosillo, Luigi
AU  - Mosillo L
FAU - Sordini, Paolo
AU  - Sordini P
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20090211
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Cardiac Surgical Procedures
MH  - Combined Modality Therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Mediastinitis/drug therapy/microbiology/surgery
MH  - Middle Aged
MH  - Negative-Pressure Wound Therapy/*methods
MH  - Postoperative Care/methods
MH  - Prospective Studies
MH  - Reoperation/instrumentation/methods
MH  - Sternum/*surgery
MH  - Surgical Wound Infection/drug therapy/microbiology/*surgery
MH  - Treatment Outcome
EDAT- 2009/02/14 09:00
MHDA- 2009/11/10 06:00
CRDT- 2009/02/14 09:00
PHST- 2008/07/28 00:00 [received]
PHST- 2008/12/08 00:00 [revised]
PHST- 2008/12/18 00:00 [accepted]
PHST- 2009/02/14 09:00 [entrez]
PHST- 2009/02/14 09:00 [pubmed]
PHST- 2009/11/10 06:00 [medline]
AID - S1010-7940(08)01272-4 [pii]
AID - 10.1016/j.ejcts.2008.12.036 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2009 May;35(5):833-8. doi: 10.1016/j.ejcts.2008.12.036. 
      Epub 2009 Feb 11.