Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.
Kim, Joo Hyoung;Park, Myoung Chul;Lee, Il Jae;Park, Dong Ha
Archives of Plastic Surgery
/
v.33
no.5
/
pp.632-636
/
2006
Purpose: Methicillin-Resistant-Staphylococcus aureus(MRSA) has been increasingly recognized as a cause of nosocomial infection. MRSA is hardly-controllable organism among the pathogen of nosocomial infection, because it is resistant to most antibiotics except vancomycin, and local treatment with most antiseptics are not effective to eradicate MRSA from the infection. The effectiveness of Vacuum-Assisted-Closure(VAC) was reported widely. we tried to modify original VAC. We tried VAC dressing on MRSA infected wound to evaluate whether or not the VAC is effective to eradicate MRSA which existed in the open wound. Methods: From September 2003 to December 2003, 24 patients admitted to the plastic and reconstructive surgery and orthopedic surgery, were studied. All patients were found to be positive in previous wound. Using clinical randomized study, 24 patients were divided into two groups: VAC dressing group and the $Betadine^{(R)}$ dressing group(control). During treatment, wound culture was done twice a week for evaluation of MRSA infection elimination. Results: The mean period that MRSA become not detected in all case was 17.1 days in VAC dressing group, and 25.8 days in control group, respectively. The p value was 0.013. The result reveals that the VAC dressing group is more effective to MRSA infection control. As a result, the VAC dressing was more effective in MRSA infected wound than conventional dressing. Conclusion: Through this study, we found objective result of VAC dressing. We hope that VAC dressing is more widely applied to fresh and infected wound.
Purpose: Open fractures of the foot and ankle require prompt repair of the wound due to the complexity of anatomy, insufficiency of soft tissues and inadequate blood supply. Early flaps and skin grafts are used for this purpose yet general condition of the patient as well as local wound environment often precludes such treatment options. Vacuum- Assisted Closure (VAC) is recently being used in such cases. This study was done to validate the use of VAC together with silver antimicrobial dressing materials in contaminated open fracture wounds. Materials and Methods: We have selected 10 patients with Gustillo-Anderson type III open fractures of the foot & ankle treated with VAC and silver antimicrobial dressing materials from March 2007 to January 2008. The relationship between duration of treatment with wound size, contamination, and degree of soft tissue damage was analyzed. Results: The average age of patients was 36.6 years. The average amount of VAC application time was 23.4 days. Silver dressing materials were used for 16.8 days. Average wound healing time was 51.9 days. Statistically significant relationship was found between wound size, VAC application time and silver dressing material application time. No complications such as osteomyelitis were found after treatment. Conclusion: VAC technique is recently being used in open fractures with wide skin and soft tissue defects, producing good results. A wide array of dressing materials such as silver dressing is in development. We have incorporated the VAC technique together with silver dressing materials in the treatment of open fractures and achieved complication free results.
Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.
Purpose: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study was evaluate usefulness of the VAC (Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra$^{(R)}$ in reconstruction of burn scar contracture. Methods: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The average patient's age was 19.7 years (range 5 - 27) and average surface area was $785cm^2$ (range 24 - 1600). The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra$^{(R)}$ was sutured in place with skin staple와 Steri - strip$^{(R)}$. Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra$^{(R)}$. Negative - Pressure ranging from 100 to 125 mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP - site$^{(R)}$. The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra$^{(R)}$ deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006 ~ 0.008 inches) was performed after silicone sheet removal. Result: The mean time for clinically assessed incorporation of Integra$^{(R)}$ was 10.00 days (range 9 - 12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra$^{(R)}$ had successful incorporation in tissue without serious complications. Conclusion: Integra$^{(R)}$ in combination with Vacuum - Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.
Purpose: A group of patients who were hospitalized for diabetic foot ulcers was classified according to the University of Texas Staging System for Diabetic Foot Ulcers, and we attempted to evaluate whether this staging system could be a criterion for treatment success using vacuum-assisted closure (VAC) technique. Materials and Methods: A total of 32 patients were diagnosed with diabetic foot ulcers according to the University of Texas Staging System for Diabetic Foot Ulcers. Of these, 24 patients who were evaluated as stage B according to the staging system were classified as Group 1, and 8 patients in stage D were classified as Group 2. After applying VAC, the treatment success rate was compared by evaluating the size and severity of ulcers between the two groups. Results: The grade of granulation after VAC was on average 3.75±0.53 in Group 1 and 2.25±0.71 in Group 2. There was better granulation after VAC application in Group 1 (p<0.01). The success rate of the treatment was 22 cases (91.67%) in Group 1 and one case (12.5%) in Group 2. Thus there were statistically significant differences in the success rate of treatment between groups 1 and 2 (Pearson's chisquare test, p=0.01; odd ratio 77.00, 95% confidence interval [CI] 1.26~14.66; relative risk 4.30, 95% CI 1.26~14.66). Conclusion: These results suggest that there was a higher success rate of treatment with VAC in stage B patients. The University of Texas Staging System for Diabetic Foot Ulcers can thus be an index for applying VAC to patients with infective diabetic foot ulcers.
Kim, Jae-In;Choi, Hwan-Jun;Choi, Chang-Yong;Yang, Hyung-Eun
Archives of Plastic Surgery
/
v.37
no.2
/
pp.182-186
/
2010
Purpose: Intramuscular stimulation (IMS) shows good results in the treatment of chronic pain patients who did not respond to other treatments such as oral analgesics, trigger point injection, nerve block and epidural steroid injection. But, IMS procedure especially, patients with diabetes mellitus (DM) has sometimes serious problem. So, we present a very rare case of intramuscular abscess in the sternocleiomastoid muscle after IMS with literature review. Methods: A 66 year old male visited our department 7 days after IMS in the neck. His premorbid conditions and risk factors of deep neck infection was DM and old age. Computed tomographic scans of the head and neck region were performed in this patient: signs of deep neck infection, were seen enhanced abscess in the sternocleidomastoid muscle, cellulitis overlying tissue of the neck, and air bubbles involved muscle. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure (VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, drainage of the abscess with the VAC system, and then primary closure. The postoperative course was uneventful. Results: We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the techniques with a clear understanding of the medical disorders of patients. And, the refined technique using the VAC system can provide a means of simple and effective management for the cervical intramuscular abscess, with better cosmetic and functional results.
Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.
Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.
Chim, Harvey;Zoghbi, Yasmina;Nugent, Ajani George;Kassira, Wrood;Askari, Morad;Salgado, Christopher John
Archives of Plastic Surgery
/
v.45
no.1
/
pp.45-50
/
2018
Background Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity. Methods Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients. Results There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was $6.4{\pm}6.4mm$, while flap thickness for the exposed flap group was $29.6{\pm}13.5mm$. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group. Conclusions Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.
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