Negative Pressure Therapy as a Treatment Modality for Surgical Site Infection in Cardiac Surgery

Abstract

Background: Negative pressure therapy (NPT), primarily introduced for the treatment of pressure ulcers or chronic debilitating wounds, has recently emerged as a novel treatment strategy in the field of cardiac surgery, providing superior results to the conventional therapeutic strategies.

Patients and methods: From November 2004 to October 2005, 25 patients underwent NPT (negative pressure therapy). Four patients (16%) were treated for extensive leg-wound infections, 10 (40%) were treated for superficial sternal wound infections and 11 (44%) for deep sternal wound infections. The median age was 67.9 years (range 48 to 79) and the median BMI was 34.2 kg/m² (range 28 to 41). Because of wound infection complications, 11 patients (44%) were re-admitted to the department. In 13 patients (52%), NPT was employed after the failure of the conventional treatment strategy.

Results: All 25 patients were successfully healed. In-hospital mortality was 0% and 30-day survival was 100%. The overall length of hospitalization reached 36.4 days (range 11 to 62). The median number of dressing changes was 4.9 (range 3 to 9). The median NPT treatment time until the surgical closure was 9.7 days (range 6 to 24 days). In 17 patients (68%), the excessive residual sternal defect required a local advancement flap transfer. One patient (4%) with a chronic wire-related fistula was re-admitted 6 months after NPT therapy.

Conclusion: NPT therapy can be considered as an effective treatment strategy associated with a low risk of procedure failure and wound infection recurrence, particularly in the management of sternal wound infection after cardiac surgery.

Key Words:

• Vacuum assisted closure
• cardiac surgery
• sternal infection
• mediastinitis

Additional information

Notes on contributors

M. Simek

M. Simek, M.D. Department of Cardiac Surgery University Hospital and Palacky University Faculty of Medicine I. P. Pavlova 6, 775 20 Olomouc, Czech Republic Tel.: [phone] Fax: [phone] E-mail: [email protected]