Vacuum-assisted Closure Therapy In Management Of Post Cardiac Surgery Wound Dehiscence
Ibrahim M. Yassin1, Farouk M. Oueida2.
1Tanta University Hospitals, Tanta, Egypt, 2Saud al Babtin Cardiac Center, AL DAMMAM, Saudi Arabia.
OBJECTIVE: Although the incidence of surgical Wound Dehiscence (WD) after cardiac surgery is an uncommon complication but it is considered as a major one if it is deep and infected. Sternal Wound Dehiscence (SWD) is the most common one. It influence peri-operative morbidity and mortality. We sought to evaluate the results of the recent introduction of vacuum-assisted closure (VAC) therapy in the management plan, compared with those of previous conventional treatments.
METHODS: Retrospective data collection for two groups of consecutive patients with post cardiac surgery (WD) from Jan.2008 to June 2016. (GroupI) (VAC Therapy group) (50patients) and (GroupII) (Conventional Therapy group) (25patients). The preoperative risk factors, degree of wound infection, incidence of mortality, mediastinitis, sepsis, and hospital course were evaluated
RESULTS: The major preoperative comorbidities were comparable in both groups. There were statistically significant better results in Group1, Mortality rate (0 vs 3(12%); P< 0.05). Incidence of mediastinitis (1 (2%) vs 6(24%) P < 0.01), Sepsis (0 vs 4(16%)< 0.05). Surgical sternal revision (1(2%) vs 16(64%)P < 0.000), Surgical superficial revision (7(14%) vs 9(36%) P = 0.21), delayed infection (1 (2%) vs 6(24%) P < 0.01) and referral to plastic surgery for muscle flaps (0 vs 6(24%); P< 0.001). .There was statistically significant difference regarding the ICU and Hospital stay in Group1 (5 ± 6 vs 8 ± 11days) p<0.05 and ( 32 ± 25 vs 43± 36 days) p<0.05. The combination of the VAC and titanium plates significantly decreases the need for sternal revision and gives the best outcome. The VAC Usage extended beyond the SWD to other surgical sites, We recorded good outcome in two cases of lower limb post-fasciotomy (due to post-cardiac surgery compartmental syndrome ) and other two deep pocket infection (Permanent Pacemaker-PPM and Left Ventricular Assistant Device-LVAD).
CONCLUSIONS: The use of VAC therapy is essential in management of all types of post-cardiac surgery WD. VAC Usage seems to open the door significantly to less invasive management of these cases essentially amenable for sternal revision and its associated risk. It is considerably effective in decreasing mortality, morbidity and accompanied with better hospital course.
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