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Stepwise low-pressure VAC for deep sternal infection in a 2.8-kg infant
Sanketh Edem1, Sachin Mahajan1, Jigyasa Bharti1
1Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Low-pressure vacuum-assisted closure (VAC) effectively treated deep sternal wound infection in a ventilated infant. This method proved safe and aided recovery for critically ill neonates with unstable chest walls.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Deep sternal wound infection (DSWI) is a rare but serious complication following cardiac surgery in infants.
- Ventilated infants with unstable chest walls pose unique challenges for wound management due to risks associated with high negative pressures.
Purpose of the Study:
- To evaluate the safety and efficacy of low-pressure vacuum-assisted closure (VAC) for DSWI in a mechanically ventilated, very-low-weight infant.
- To demonstrate an alternative wound management strategy for complex pediatric surgical site infections.
Main Methods:
- A 2-month-old infant with DSWI post-cardiac repair was treated with polyurethane-foam VAC.
- Therapy was initiated at low negative pressure (-40 mmHg), gradually increased to -50 mmHg, with dressings changed every third day.
- Debridement was performed prior to VAC application.
Main Results:
- The VAC therapy promoted progressive wound granulation over 12 days.
- The deep sternal wound healed successfully by secondary intention.
- The infant was extubated, recovered well, and was discharged on postoperative day 42.
Conclusions:
- Stepwise low-pressure VAC is a safe and effective treatment for DSWI in ventilated, very-low-weight infants.
- This approach mitigates risks associated with conventional high negative pressures in fragile patients.
- VAC therapy offers a viable solution for complex pediatric wound management.
Abstract:
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.
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