Top

General Thoracic and Cardiovascular Surgery

Published in:

01-08-2016 | Original Article

Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery

Authors: Akihiro Yoshimoto, Takafumi Inoue, Masayuki Fujisaki, Sei Morizumi, Yoshihiro Suematsu

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2016

Abstract

Objective

Surgical site infection (SSI) after cardiovascular procedures is a severe complication, potentially leading to high morbidity and mortality. In addition, during the treatment of SSI, rehabilitation is delayed, which can severely impair postoperative recovery. The aim of this study was to assess the effect of vacuum-assisted closure (VAC) therapy on rehabilitation during the treatment of SSI after cardiovascular surgery.

Methods

From January 2008 to March 2015, 10 patients underwent VAC therapy for SSI after cardiovascular operations. The patient characteristics, duration of VAC therapy, time interval from the implementation of VAC to physical therapy (PT) (T1), ambulation (T2) and walking (T3), functional independent measure (FIM), and maximum consecutive walking capacity (MCWC) were retrospectively analyzed.

Results

Nine patients underwent mid-sternal incision and one patient underwent thoraco-abdominal incision. The mean time interval from the beginning of VAC therapy to PT, ambulation, and walking was 0.38 ± 0.50, 0.63 ± 0.71, and 1.38 ± 1.86 days, respectively. The average FIM was 84.5 ± 14.0 at the beginning of VAC therapy and 106.7 ± 18.5 at the end of VAC therapy (P = 0.000494). On average, MCWC was 52.3 ± 54.6 m at the installation of VAC therapy and 189.7 ± 152.8 m at the completion of VAC therapy (P = 0.0169). FIM and MCWC improvement rate was better in VAC group than non-VAC group although these data are not suitable for statistical analysis because of a small sample size.

Conclusions

Although further studies are warranted, VAC therapy may have a role in facilitating rehabilitation and improving the prognosis of SSI cases after major cardiovascular operations.

Simek M, Nemec P, Zalesak B, Kalab M, Hajek R, Jecminkova L, Kolar M. Vacuum-assisted closure in the treatment of sternal wound infection after cardiac surgery. Biomed Pap Med Univ Palacky Olomouc Czech Repub. 2007;151(2):295–9.CrossRef

Vos RJ, Yilmaz A, Sonker U, Kelder JC, Kloppenburg GTL. Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing. Interact Cardiovasc Thorac Surg. 2012;14:17–21.CrossRefPubMed

Finkelstein R, Rabino G, Mashiah T, et al. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control. 2005;33:450–4.CrossRefPubMed

Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factor and mortality. Eur J Cardiothorac Surg. 2001;20:1168–75.CrossRefPubMed

Suzuki T, Kawamoto Shunsuke, Motoyoshi N, Akiyama M, Kumagai K, Adachi O, Hayatsu Y, Ito K, Matsuo S, Saiki Y. Contemporary outcome of the surgical management of prosthetic graft infection after a thoracic aortic replacement: is there a room to consider vacuum-assisted wound closure as an alternative? Gen Thorac Cardiovasc Surg. 2015;63:86–92.CrossRefPubMed

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control. 1999;27:97–132.CrossRefPubMed

Fuchs U, Zittermann A, Stuetten B, Groening A, Minami K, Koefer R. Clinical outcome of patients with deep sternal infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. Ann Thorac Surg. 2005;79:526–31.CrossRefPubMed

Fleck TM, Fleck M, Moidl R, et al. The vacuum-assisted closure system for the treatment of deep sternal wound infection after cardiac surgery. Ann Thorac Surg. 2002;74:1596–600.CrossRefPubMed

Immer FF, Durrer M, Muehlemann KS, Erni D, Galh B, Carrel TP. Deep sternal infection after cardiac surgery: modality of treatment and outcome. Ann Thorac Surg. 2005;80:957–61.CrossRefPubMed

10.

Sjogren J, Malmsjo M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg. 2006;30:898–905.CrossRefPubMed

11.

Sjogren J, Gustafsson R, Nilsson J, Malmsjo M, Ingemansson R. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg. 2005;79:2049–55.CrossRefPubMed

12.

Higashita R, Asai T, Shiraishi S, Matsubayashi K, Nishi T, Kurokawa M. Vacuum-assisted closure for infections after cardiovascular surgery. Jpn J Cardiovasc Surg. 2006;35:127–31.CrossRef

13.

Wackenfors A, Sjoegren J, Gustafsson R, Algotsson L, Ingemannsson R, Malmsjo M. Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood flow. Wound Repair Regen. 2004;12:600–6.CrossRefPubMed

14.

Kawata M, Nishimura T, Hoshino Y, Kinoshita O, Hisagi M, Ando M, Morota T, Motomura N, Kyo S, Ono M. Negative pressure wound therapy for left ventricular assist device-related mediastinitis: two case reports. J Artif Organs. 2011;14(2):159–62.CrossRefPubMed

15.

Kinoshita O, Nishimura T, Kawata M, Ando M, Kyo S, Ono M. Vacuum-assisted closure with Safetac technology for mediastinitis in patients with a ventricular assist device. J Artif Organs. 2010;13(2):126–8.CrossRefPubMed

Title: Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery
Authors: Akihiro Yoshimoto
Takafumi Inoue
Masayuki Fujisaki
Sei Morizumi
Yoshihiro Suematsu
Publication date: 01-08-2016
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 8/2016
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-016-0664-x

At a glance: The STEP trials

Springer Medicine

Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2016

Erratum to: Thoracic and cardiovascular surgery in Japan during 2013

Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma

Aortic valve replacement and prosthesis-patient mismatch in the era of trans-catheter aortic valve implantation

Therapeutic strategy for small-sized lung cancer

Coronary artery bypass grafting in a patient with hemophilia B: continuous recombinant factor IX infusion as per the Japanese guidelines for replacement therapy

Plural large floating thrombi in the ascending aorta