A new technique for the treatment of delayed sternotomy healing: the vacuum therapy

The treatment of nonhealing and infected sternotomies after cardiac surgery is a challenging task, with its increased rates of mortality, morbidity, and costs. Local vacuum therapy (V.A.C. system) allows treatment of local infections, thanks to continuous aspiration and the sealed dressing that stimulates granulation tissue formation. The purpose of this clinical investigation was to evaluate vacuum therapy in cardiac surgery for achieving healing of delayed sternotomy closure after cardiac surgery.

From January 1998 to December 2002, 7 patients who underwent coronary artery bypass surgery under cardiopulmonary bypass by median sternotomy approaches presented a nonhealing infected sternal surgical wound that was treated with local vacuum therapy. Aspiration maintained between -125 mm Hg and -200 mm Hg was carried out on the entire surface of the wound with a sponge connected hermetically to an aspiration system. The treatment was associated with antibiotic therapy adapted to the results of bacteriological studies of the aspirates.

All patients with delayed sternotomy closure healed in approximately 8 weeks (2-12 weeks) with the exception of one patient who died of multiorgan failure after a satisfactory muscular pectoral flap. Treatment was possible with vacuum therapy alone (n = 2), with vacuum therapy in association by second intention with a skin graft (n = 1), or both with a muscular pectoral flap (n = 4). Sternal stability appears to be an important factor for achieving satisfactory and complete healing.

This new therapy offers an alternative to the classic treatment of infected sternotomies in cardiac surgery, especially in preparing rewiring and muscular flaps for complicated cases with sternal instability or alone. The treatment must be instituted early to be more effective.