Mediastinitis after cardiac procedures via median sternotomy: comparative analysis of outcomes

Aim. To compare the effectiveness of poststernotomy mediastinitis treatment in 41 patients who underwent vacuum-assisted closure or closed irrigation treatment. Methods. A retrospective analysis of 41 cases of sternal wound infection identified in patients who underwent cardiac surgery between 2007 and 2012. 18 patients (the first group) were treated using closed irrigation, 23 patients (the second group) - using vacuum-assisted closure. We compared the time interval for wound healing and drainage, serum levels of C-reactive protein and blood leukocyte counts on admission and at different time points until discharge. Results. In patients who were treated using vacuum-assisted closure, wound debridement and healing were achieved at shorter terms, and lower rate of complications were observed. There were 8 (44.4%) relapses requiring repeated surgery and debridement in the first group compared to 3 (13%, p=0.01) in the second group. C-reactive protein level decreased more rapidly in patients who were treated using vacuum-assisted closure (p <0.02). The duration of hospital stay was 67±4.1 days in the first group compared to 29.6±8.4 days in the second group (p=0.019). Moreover, patients who were treated using vacuum-assisted closure did not experience any significant discomfort and stayed active. Histological examination of the soft tissues showed marked lymphoid and plasma-cell reaction and neoangiogenesis by the end of the second week of vacuum-assisted closure. Conclusion. The use of vacuum-assisted closure shortens the term of wound debridement, granulating tissue formation and the duration of hospital stay compared to closed irrigation treatment.

poststernotomy mediastinitis, vacuum-assisted closure, closed irrigation treatment