The vacuum-assisted closure device as a bridge to sternal wound closure

Sixteen patients were treated for sternal wound infections after undergoing cardiac procedures. Their management involved prompt surgical debridement and quantitative wound biopsies. At the time of the initial debridement, th e Vacuum-Assisted Closure Device (V.A.C.) was placed in the open sternal wo und. A subatmospheric environment was maintained by the device at a level o f 75 to 150 mmHg, The V.A.C, sponge was changed every 2 to 3 days, and oper ative debridement was performed until quantitative biopsies showed resoluti on of infection or until systemic signs of sepsis had resolved. At this tim e the sternal wounds were closed with regional muscle flaps. Patients were excluded from the use of the device if the pleural cavity was entered durin g operative debridement. Fifteen of the 16 patients survived and went on to complete wound healing and discharge from the hospital (average length of stay, 16.7 days). One patient sustained a cardiac dysrhythmia during the mu scle flap procedure and died, There were no complications related directly to the use of the V.A.C. It is the opinion of the authors that the V.A.C. o ffers several advantages over their traditional methods of treatment. They noted improvement in sternal wound stabilization during the perioperative p eriod and a decreased need for paralysis and mechanical ventilation. Wound management was improved by avoiding the need to perform debridement or to m ake desiccating dressing changes to an open sternum. Moreover, they also th ink that this device may lessen the risk for ventricular rupture because of better control of the wound environment and markedly improved stabilizatio n of the debrided sternal elements.