227 Experience with Vacuum-Assisted Closure of Sternal Wound Infections Following Cardiac Surgery and Evaluation of Chronic Complications Associated with its Use Vinayak Bapat, F.R.C.S. (C.Th), * Naguib El-Muttardi, F.R.C.S.,† Christopher Young, F.R.C.S. (C.Th), * Graham Venn, F.R.C.S. (C.Th), * and James Roxburgh, F.R.C.S. (C.Th) * ∗ Department of Cardiothoracic Surgery; and †Department of Plastic Surgery, St. Thomas’ Hospital, London, UK ABSTRACT Objectives: We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treat- ment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Methods: Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D). Patients were discharged after satisfactory wound closure. Upon discharge patients were followed up at interval of three to six months. Recurrent sternal problems when identified were investigated and additional surgical proce- dures were carried out when necessary. Results: There were nine deaths, all due to unrelated causes except in one patient who died of right ventricular rupture (Group C). Nine patients in Group A had recurrent wound problems of which six had VAC system for > 21 days. Three patients underwent extensive debridement due to sternal osteomyelitis. All eight patients in Group B presented with chronic wound-related problems and underwent multiple debridements. Four patients had laparoscopic omental flaps. In contrast 14 pa- tients (Group B and D) who were treated with shorter duration of VAC followed by either a flap or direct surgical closure, did not present with recurrent problems. Conclusion: VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replace- ment for surgical closure of sternal wound appears to be associated with recurrent problems of the sternal wound. Strategy of use of VAC for a short duration followed by early surgical closure appears favorable. doi: 10.1111/j.1540-8191.2008.00595.x (J Card Surg 2008;23:227-233) Since the introduction of median sternotomy by Julian in 1956, sternal wound infections have been a po- tentially life-threatening complication after open heart surgery and the reported incidence ranges from 1% to 5%. 1 There is still no consensus regarding ideal treat- ment of this complication. Despite improvements in an- tibiotic treatment and techniques of wound care, this complication is associated with high incidence of mor- bidity and mortality. 2 Treatment of mediastinitis has evolved over the past few decades from closed mediastinal antibiotic irriga- tion pioneered by Mandelbaum in 1963, 3 to the use of pectoralis muscle flap in 1980s by Jurkiewicz 4 One of Address for correspondence: Vinayak Bapat, 123 Turney Road, London SE21 &JB, UK. Fax: 0044-207-188-1016; e-mail: vnbapat@yahoo.com the favored treatments today includes surgical debride- ment, followed by delayed surgical closure with or with- out pectoral muscle flap or omental flap, depending on the severity of the infection. 5-10 The Vacuum-assisted closure (VAC) system was first introduced by Argenta and Morykwas in 1997 for the treatment of pressure ulcers and other chronic ul- cers. 11 Since then, the application of VAC system has increased steadily over time. VAC system usage in treatment of mediastinitis has gained popularity and has been used either alone or as an adjunct to other methods of treatment. 12-19 Few of the cited advan- tages of VAC over other modalities of treatments are lowering mortality and morbidity and reduced hospi- tal stay. 16,17 Although the popularity of VAC system is on rise, there are no reports on adverse effects of