Kocaeli Med J. 2015; 4(3): 21-29

The Efficiency of Vacuum Assisted Closure Method for Treatment of Deep Sternal Infections Following Open Cardiac Surgery

Hüseyin Þaþkýn¹, Çaðrý Düzyol¹, Kazým Serhan Özcan², Hüseyin Maçika³, Mustafa Ýdiz^4
1Derince Training and Research Hospital, Department of Cardiovascular Surgery, Kocaeli, Turkey
²Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
³Acibadem Hospital, Department of Anesthesiology and Reanimation, Kocaeli, Turkey
⁴Acibadem Hospital, Department of Cardiovascular Surgery, Kocaeli, Turkey

INTRODUCTION: In this study, we aimed to compare the conventional treatment methods with vacuum assisted closure treatment technique for mortality, re-infection and duration of hospitalization in patients who had deep sternal wound infection after cardiac surgery.
METHODS: Seventy two patients who had deep sternal infection after open heart surgery between November 2006-June 2014 were enrolled in the study. The data were collected retrospectively. The patients who were treated with conventional wound care were enrolled in group 1(n=38), the patients who were treated with vacuum assisted closure were enrolled in group 2 (n=34).
RESULTS: Twenty five of the patients were female and the mean age of the patients were 65,3±7,8 years. The mean values of C-reactive protein(p=0.02), leukocyte counts(p=0.01) and erythrocyte sedimentation rate (p=0.005) were significantly different between the groups. The incubation of sternal and mediastinal swap at 10 days were positive in 26 patients in group 1(68,4%), and positive in 5 patients in group 2(14,7%)(p=0.0001). The 90-days mortality; no mortality was observed in group 1, and 6 of patients(%15,8) died in group 2 (p=0.03). The duration of hospitalization in survived patients were 23,3±5,5 days in group 1 and were 17,3±3,4 days in group 2 (p=0.0001).
DISCUSSION AND CONCLUSION: The patients who were treated with vacuum assisted closure when compared to conventional wound care, for deep sternal wound infection after cardiac surgery, were associated with shortened hospital stay, accelerate in wound healing and eradication of microorganisms.

Keywords: Cardiac surgery, sternal infections, vacuum assisted closure therapy

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Açýk Kalp Cerrahisi Sonrasý Geliþen Derin Sternal Enfeksiyonlarýn Tedavisinde Vakum Yardýmlý Kapama Yönteminin Etkinliði

Hüseyin Þaþkýn¹, Çaðrý Düzyol¹, Kazým Serhan Özcan², Hüseyin Maçika³, Mustafa Ýdiz^4
1Derince Eðitim Ve Araþtýrma Hastanesi, Kalp Ve Damar Cerrahisi Kliniði, Kocaeli
²Derince Eðitim Ve Araþtýrma Hastanesi, Kardiyoloji Kliniði, Kocaeli
³Acýbadem Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Kocaeli
⁴Aýbadem Hastanesi, Kalp Ve Damar Cerrahisi Kliniði, Kocaeli

GÝRÝÞ ve AMAÇ: Bu çalýþma, kardiyak cerrahi sonrasý geliþen derin sternal yara enfeksiyonlarýnda konvansiyonel tedavi yöntemleriyle vakum yardýmlý kapama tedavi yönteminin uygulandýðý hastalarýn ölüm, reenfeksiyon ve hastanede kalýþ sürelerini karþýlaþtýrmak için tasarlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya Kasým 2006-Haziran 2014 tarihleri arasýnda ayný merkezde açýk kalp cerrahisi sonrasý derin sternal yara enfeksiyon tanýsýyla tedavi uygulanan 72 hasta dâhil edildi. Hasta verileri retrospektif olarak incelendi. Konvansiyonel yara bakýmý ve pansuman yöntemleriyle tedavi uygulanan hastalar Grup 1(n=38), vakum yardýmlý kapama yöntemiyle tedavi uygulanan hastalar ise Grup 2(n=34) olarak sýnýflandýrýldý.
BULGULAR: Hastalarýn 25’i kadýn olup yaþ ortalamasý 65,3±7,8 yýldý. Tedavinin 7.gününde bakýlan ortalama C-reaktif protein(p=0.02), ortalama lökosit sayýsý(p=0.01) ve ortalama eritrosit sedimantasyon hýzý(p=0.005) deðerleri açýsýndan gruplar arasýnda anlamlý fark mevcuttu. Tedavinin 10.günü alýnan mediastinal veya sternal yara akýntý kültüründe Grup 1’de 26 hastada(68,4%), Grup 2’de ise 5 hastada(14,7%) mikroorganizma üremesi mevcuttu(p=0.0001). Doksan günlük mortalite Grup 1’de geliþmezken Grup 2’de ise 6 hasta(%15,8)’da geliþti(p=0.03). Sað kalan hastalarýn hastanede kalýþ süreleri Grup 1’de ortalama 23,3±5,5 gün iken Grup 2’de ise 17,3±3,4 gündü(p=0.0001).
TARTIÞMA ve SONUÇ: Açýk kalp cerrahisi sonrasý geliþen derin sternal yara enfeksiyonlarýn tedavisinde vakum yardýmlý kapama yöntemi konvansiyonel tedavi yöntemlerine göre yara iyileþmesini hýzlandýran, hastanede kalýþ süresini kýsaltan ve yara yerindeki mikroorganizmalarýn daha erken eradikasyonunu saðlayan güvenli ve etkili bir yöntemdir.

Anahtar Kelimeler: kardiyak cerrahi, sternal enfeksiyon, vakum yardýmlý kapama tedavisi

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