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Vacuum-assisted closure system for the treatment of mediastinitis after total aortic arch replacement

Yoshikatsu Saiki1, Masaki Hata, Junetsu Akasaka

  • 1Department of Cardiovascular Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|January 18, 2006
PubMed

Insights

A deep sternal wound infection after aortic arch replacement was successfully treated using vacuum-assisted closure and omental transfer. This approach prevented recurrent infection, demonstrating its effectiveness in complex cardiac surgery cases.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Disease Management
  • Wound Healing Research

Background:

  • Deep sternal wound infection (DSWI) poses a significant risk following aortic arch surgery.
  • Enterobacter cloacae is a challenging pathogen in post-sternotomy infections.
  • Early and effective management is crucial to prevent graft complications and mediastinitis.

Observation:

  • A 77-year-old male patient presented with DSWI caused by Enterobacter cloacae 4 days post-total aortic arch replacement.
  • Initial treatment involved mediastinal reexploration, open drainage, and subsequent application of a vacuum-assisted closure (VAC) system for 10 days.
  • Enhanced granulation and neovascularization were observed during VAC therapy.

Findings:

  • The VAC system promoted significant wound bed preparation, facilitating further surgical intervention.
  • Omental transfer combined with chest closure was successfully performed on the 18th postoperative day.
  • The patient remained free of mediastinal or graft infection during a 19-month follow-up period.

Implications:

  • This case highlights the successful application of a multi-modal approach combining VAC therapy and omental flap for complex DSWI.
  • The findings suggest that VAC therapy can effectively prepare the wound bed for reconstructive procedures in post-sternotomy infections.
  • This strategy offers a viable solution for managing severe sternal wound complications after major aortic surgery.

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