Yamauchi Akihiko, Hashimoto Makoto
Department of Cardiovascular Surgery, Tomishiro Central Hospital, Tomishiro, Japan.
Kyobu Geka. 2013 Jun;66(6):464-8.
Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious complication in cardio-thoracic surgery. In mediastinitis cases, acute thoracic aortic graft infection is a lethal status. We described a successful treatment of MRSA thoracic graft infection by V.A.C. ATS therapy. Ascending aortic graft replacement was performed in a 55-year-old man, and deep mediastinitis by MRSA occurred on postoperative day 6. On postoperative day 8, negative pressure wound therapy (NPWT) using a home-made system, was carried out after re-sternotomy, debridement of inflammatory tissues and irrigation. Following the 1st NPWT, V.A.C. ATS therapy was introduced. MRSA vanished from the mediastinum after V.A.C. ATS therapy, and the mediastinum was closed with the omentum. He was discharged 43 days after the 1st operation. We consider that the advantage of V.A.C. ATS therapy is "making a bed-side free status" in even mediastinitis patients, which enables active walking and reinforcement of physical strength. V.A.C. ATS therapy might be useful for the treatment of MRSA mediastinitis.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的纵隔炎是心胸外科手术中的一种严重并发症。在纵隔炎病例中，急性胸主动脉移植物感染是一种致命状态。我们描述了通过V.A.C. ATS疗法成功治疗MRSA胸移植物感染的案例。一名55岁男性接受了升主动脉移植物置换术，术后第6天发生了由MRSA引起的深部纵隔炎。术后第8天，在再次开胸、清创炎性组织并冲洗后，使用自制系统进行了负压伤口治疗（NPWT）。在第一次NPWT之后，引入了V.A.C. ATS疗法。经过V.A.C. ATS疗法后，纵隔中的MRSA消失，纵隔用网膜封闭。他在第一次手术后43天出院。我们认为V.A.C. ATS疗法的优势在于即使对于纵隔炎患者也能“创造床边无负担状态”，这使得患者能够积极活动并增强体力。V.A.C. ATS疗法可能对MRSA纵隔炎的治疗有用。
