Tremendous bleeding complication after vacuum-assisted sternal closure.

Area of Science:

• Surgical innovation
• Wound management
• Cardiac surgery complications

Background:

• Vacuum-assisted closure (VAC) is increasingly used for complex infected wounds.
• The VAC system utilizes negative pressure to aid wound healing.
• Effectiveness in improving microcirculation and granulation is established.
• No contraindications for deep sternal wounds in cardiac surgery were previously noted.

Observation:

• A case report details severe ascending aorta bleeding in a cardiac surgery patient.
• Bleeding was caused by wire fragments penetrating the vessel during VAC therapy.
• The patient had undergone sternal closure with wire fragments potentially remaining.

Findings:

• The effectiveness of VAC in promoting wound healing is well-documented.
• This case highlights a critical risk associated with retained sternal fragments.
• Inadequate removal of foreign material can lead to catastrophic vascular complications.

Implications:

• Thorough removal of all foreign particles in the sternum is crucial before VAC application.
• This finding necessitates a re-evaluation of pre-VAC protocols in cardiac surgery.
• Enhanced vigilance is required to prevent VAC-related hemorrhage in sternal wound management.