Thorac Cardiovasc Surg 2011; 59(1): 25-29
DOI: 10.1055/s-0030-1250598
Original Cardiovascular/Society Paper

© Georg Thieme Verlag KG Stuttgart · New York

Vacuum-Assisted Wound Closure is Superior to Primary Rewiring in Patients with Deep Sternal Wound Infection[*]

A. Assmann1 , U. Boeken1 , P. Feindt1 , P. Schurr1 , P. Akhyari1 , A. Lichtenberg1
  • 1Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany
Further Information

Publication History

received July 31, 2010

Publication Date:
17 January 2011 (online)

Abstract

Objective: Deep sternal wound infections are serious complications after cardiac surgery. The aim of the present study is to compare the outcome after vacuum-assisted wound closure to that after primary rewiring with disinfectant irrigation. The study additionally focuses on defining predictors for the failure of primary rewiring and its impact on postoperative outcome. Methods: Retrospective analysis was performed in 5232 patients who underwent cardiac surgery with a median sternotomy. 192 patients postoperatively developed deep sternal wound infections and were distributed into 2 therapy groups: a vacuum-assisted wound closure (= VAC) group and a primary rewiring (= RW) group, which was subdivided into healing after rewiring (= RW‐h) and failure of rewiring (= RW‐f). These groups were compared statistically to reveal coincidental pre-, intra- and postoperative parameters. Results: Compared to the VAC group, the RW group showed a poorer outcome, although RW baseline characteristics were apparently beneficial. Primary rewiring failed in 45.8 % of all cases, which led to even worse outcomes. Important predictors for failure of primary rewiring were morbid obesity, diabetes mellitus type II, chronic obstructive pulmonary disease, preoperatively impaired left ventricular function, postoperatively positive blood and wound cultures, bilateral harvesting of internal thoracic arteries and the need for surgical reexploration. Conclusions: In spite of patients being in a worse condition, vacuum-assisted wound closure therapy resulted in improved outcomes and thus should be preferred to primary rewiring. Moreover we report on predictors which may indicate whether there is a high risk of rewiring failure.

1 The content of this paper was presented at the 39th annual meeting of the German Society for Thoracic and Cardiovascular Surgery, Stuttgart, February 15th, 2010.

References

1 The content of this paper was presented at the 39th annual meeting of the German Society for Thoracic and Cardiovascular Surgery, Stuttgart, February 15th, 2010.

Prof. Dr. Udo Boeken

Department of Cardiovascular Surgery
University Hospital

Moorenstrasse 5

40225 Duesseldorf

Germany

Phone: +49 21 18 11 83 31

Fax: +49 21 18 11 83 33

Email: [email protected]