Stepwise low-pressure VAC for deep sternal infection in a 2.8-kg infant

A 2-month-old male infant weighing 2.8 kg developed a deep sternal wound infection on postoperative day 16 following repair of an atrial septal defect, ventricular septal defect and patent ductus arteriosus. Staphylococcus aureus was isolated on wound swab, and culture-sensitive antibiotics were given for 14 days. The infant remained intubated with an unstable chest wall, so conventional higher negative pressures were considered unsafe near the exposed mediastinum. After debridement, polyurethane-foam vacuum-assisted closure (VAC) was applied at a deliberately low -40 mmHg on day 1, increased to -50 mmHg thereafter, and changed every third day. Four cycles were completed over 12 days. The wound granulated progressively ( Figure 1) and healed by secondary intention; the infant was extubated, recovered well and was discharged on postoperative day 42. This case illustrates that stepwise low-pressure VAC is a safe, effective option for deep sternal wound infection in the ventilated, very-low-weight infant.