Saiki Yoshikatsu, Kawamoto Shunsuke, Sai Sadahiro, Tabayashi Koichi
Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan.
Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):712-4. doi: 10.1510/icvts.2008.176727. Epub 2008 May 21.
Little experience exists with the vacuum-assisted closure (VAC) therapy in the high-risk group of patients with perigraft abscess containing a large amount of prosthetic vascular grafts. We report our experience in the VAC therapy for patients with mediastinitis after aortic arch replacement. Between February 2003 and December 2006, five patients with a mean age of 72.2 years developed postoperative mediastinitis after aortic arch replacement, and were treated with the VAC system. In all the patients the mediastinal fluid and tissue examinations turned out to be negative for microbiological cultures, and successful closure of the midline incision was achieved with concomitant omental transfer after a mean duration of 22.6 days of VAC treatment. Four of the five patients survived to discharge and have been free from recurrent sign of mediastinal or graft infection at long-term follow-up. Our study indicates that the VAC treatment may reduce early mortality of life-threatening deep sternal wound infection complicated by a prior aortic arch replacement and become a preferred therapeutic option for the patients to whom another replacement is too risky.
对于大量人工血管移植物周围存在移植后脓肿的高危患者，真空辅助闭合（VAC）治疗的经验较少。我们报告了我们对主动脉弓置换术后纵隔炎患者进行VAC治疗的经验。2003年2月至2006年12月期间，平均年龄为72.2岁的5例患者在主动脉弓置换术后发生了术后纵隔炎，并接受了VAC系统治疗。所有患者的纵隔液和组织检查微生物培养结果均为阴性，在平均22.6天的VAC治疗后，通过同时进行网膜转移成功闭合了中线切口。5例患者中有4例存活出院，在长期随访中无纵隔或移植物感染复发迹象。我们的研究表明，VAC治疗可能降低先前主动脉弓置换术后危及生命的深部胸骨伤口感染的早期死亡率，并成为再次置换风险过高患者的首选治疗方案。
