J.Jpn. Surg. Soc.. 110(1): 21-26, 2009

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Feature topic

USE OF A VACUUM-ASSISTED CLOSURE SYSTEM FOR THE TREATMENT OF MEDIASTINITIS AFTER CARDIAC AND AORTIC SURGERY

The complications associated with postoperative mediastinitis represent a significant cause of morbidity and mortality within a subset of cardiac surgical patients. Reports on the most appropriate therapeutic intervention for its resolution vary. The vacuum-assisted wound closure (VAC) system is a new noninvasive treatment modality to enhance granulation in nonhealing and infected sternotomies. The system essentially provides negative pressure by controlled suction on the wound surface. We used the VAC system for the treatment of postoperative mediastinitis in 13 patients between 2003 and 2006. Twelve (92%) patients became free of mediastinitis after treatment with the VAC system, and 10 (77%) patients were eventually discharged. No adverse outcome of VAC treatment was encountered during the course of therapy. The VAC system is an efficacious treatment modality for postcardiotomy mediastinitis including deep sternal methicillin-resistant Staphylococcus aureus wound infection. Recurrent mediastinitis was not observed among the patients who underwent VAC treatment as definitive therapy and as a bridge to omental or muscle flap transfer.

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