Eur J Cardiothorac Surg 2001;19:375
© 2001 Elsevier Science NL
Continuous high vacuum and primary skin closure in sternotomy wound infection
Giuseppe Rescigno,
Maria Sandra Ballestrazzi,
Stefano Nazari
Department of Cardiac Surgery, Villa Maria Cecilia, Via Corriera 1, 48010 Cotignola (RA), Italy
Received 7 December 2000;
accepted 20 December 2000.
Corresponding author. Tel.: +39-0545-37111
e-mail: grescigno{at}aol.com
An important message in the report of A.T.M. Tang and associates [1] concerns the essential role of continuous vacuum in sternotomy wound infections healing process. Dressings by polyurethane foam sealed by transparent adhesive drape in fact are changed only once every 48 h, since wound toilette and purulent material removal actually relies on a sophisticate intermittent high suction vacuum system. We have adopted a conceptually similar, closed technique for superficial wound infections. After a favourable experience with a two stage approach [2], consisting in preliminary debridement, followed, a few days later, by a surgical closure by means of advancement flaps and multiple high suctions drains, we now carry out primary closure of the infected superficial tissues. When a superficial sternal wound infection is diagnosed, surgical debridement is carried out; a sufficient number of small high suction drains (Riplast; Neukirchen-Saar, Germany) are positioned and the skin is immediately closed by means of a continuous monofilament suture. High suction is continued until no more material is drained, usually after 7–8 days. We have treated 15 patients by this method with good results; only in one case a further debridement was necessary with second intention healing. Cosmetic results were very satisfactorily in the remaining 14 patients. Mean hospital stay after infection diagnosis was 9±2 days. We believe that, when possible, immediate skin closure after debridement over an efficient and continuous vacuum system, may be in most cases as effective as the polyurethane foam and adhesive sealant drape medication, offering better cosmetic results.
References
-
Tang A.T.M., Ohri S.K., Haw M.P. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardio-thorac Surg 2000;17:482-484.[Abstract/Free Full Text]
-
Rescigno G., Sousa Uva M., Raffoul R., Scorsin M., Lessana A. Advancement flaps to treat superficial wound infections after cardiac operations. Ann Thorac Surg 1998;66:959-960.[Abstract/Free Full Text]
