Türk Göğüs Kalp Damar Cerrahisi Dergisi-Turkish Journal Of Thoracic And Cardiovascular Surgery, vol.25, no.2, pp.174-179, 2017 (Journal Indexed in SCI Expanded)
who developed sternal wound complications following complex
congenital cardiac surgery and treated with mediastinal vacuumassisted
Methods: Between January 2014 and December 2015, a total of
473 congenital heart operations were performed in our hospital.
Of these patients, nine (8 males, 1 females; median age 24 days;
range 15 days to 14 months) underwent mediastinal vacuumassisted
closure therapy. The indication of vacuum-assisted
closure therapy was mediastinitis in five patients and sternal
wound complications in four patients.
Results: Sternum was left open in four patients after the initial
operation. The median time from opening sternum to vacuumassisted
closure therapy was 10 days (range, 7 to 15 days) in these
patients. Indications were positive mediastinal cultures in three
patients and intolerance for sternal closure due to ventricular
dysfunction and cardiac edema in one patient. In the remaining
five patients, sternal wound complications developed later and
vacuum-assisted closure therapy was applied after a median of
19 days (range, 11 to 36 days) after the operation. Mediastinal
cultures were positive in two patients. Two patients (22%) died of
sepsis and multi-organ failure. In the remaining patients, sternal
wounds were closed within seven days (range, 5 to 19 days), when
sternal cultures were negative or good granulation was obtained.
Recurrent sternal wound complication developed in one patient
(14.2%) and vacuum-assisted closure therapy was repeated. All
patients, except two, underwent vacuum-assisted closure therapy
in the intensive care unit.
Conclusion: Mediastinal vacuum-assisted closure therapy is a
good option in children with sternal wound complications after
cardiac surgery. In addition, it may accelerate the healing process
and reduce medical resource use.
Keywords: Congenital heart surgery; mediastinitis; newborn; sternum;