Yu Angela W, Rippel Radoslaw A, Smock Elliott, Jarral Omar A
Royal Free and University College Medical School, University College, London, UK.
Interact Cardiovasc Thorac Surg. 2013 Nov;17(5):861-5. doi: 10.1093/icvts/ivt326. Epub 2013 Aug 2.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether vacuum-assisted closure therapy (VAC) is superior to conventional therapy for treating post-sternotomy mediastinitis. Altogether >261 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several studies indicate that VAC therapy is associated with shorter lengths of intensive care and in-hospital stay as well as faster rates of wound healing and fewer dressing changes. It has also been shown that VAC therapy is correlated with a statistically significant reduction in reinfection rates, particularly those that occur in the early postoperative period (at the 1-week follow-up). Patients can be discharged with the dressing in situ and managed in the community with a view to delayed closure or reconstruction. However, the studies comparing VAC with conventional therapy are all retrospective in nature and reinforce the need for randomized controlled trials in order to more accurately establish differences in outcomes between VAC and conventional therapy. Additionally, owing tło the variability of treatment protocols within the non-VAC arm, it is more challenging to draw definitive conclusions regarding the superiority of VAC therapy to every modality that is considered conventional treatment. We conclude that VAC therapy is a portable and an increasingly economical option for the treatment of post sternotomy mediastinitis. Although reductions in mortality rates were not reproduced in all studies, evidence suggests that VAC should still be considered as a first-line therapy for post-sternotomy mediastinitis and as a bridge therapy to musculocutaneous reconstruction or primary closure.
根据结构化方案撰写了一篇心脏外科最佳证据主题文章。探讨的问题是真空辅助闭合疗法（VAC）在治疗胸骨切开术后纵隔炎方面是否优于传统疗法。通过报告的检索共找到261篇以上论文，其中9篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、研究的患者群体、研究类型、相关结局和结果均列于表格中。多项研究表明，VAC疗法与缩短重症监护时间和住院时间、加快伤口愈合速度以及减少换药次数相关。还表明VAC疗法与再感染率的统计学显著降低相关，尤其是术后早期（1周随访时）发生的再感染。患者可以带着敷料出院并在社区进行处理，以期延迟闭合或重建。然而，比较VAC与传统疗法的研究均为回顾性研究，这进一步凸显了进行随机对照试验的必要性，以便更准确地确定VAC与传统疗法在结局方面的差异。此外，由于非VAC组治疗方案的变异性，就VAC疗法相对于每种被视为传统治疗的方式的优越性得出明确结论更具挑战性。我们得出结论，VAC疗法是治疗胸骨切开术后纵隔炎的一种便捷且日益经济的选择。尽管并非所有研究都再现了死亡率的降低，但有证据表明，VAC仍应被视为胸骨切开术后纵隔炎的一线治疗方法以及肌肉皮瓣重建或一期闭合的过渡治疗方法。
