Lin Ye,Li Shoujun.Clinical outcomes of vacuum-assisted closure for deep sternal wound infection after pediatric cardiac surgery[J].Journal of Clinical Pediatric Surgery,,19():806-809.[doi:10.3969/j.issn.1671-6353.2020.09.009]
Clinical outcomes of vacuum-assisted closure for deep sternal wound infection after pediatric cardiac surgery
- CLC:
- R729;R625.2
- Abstract:
- Objective To retrospectively evaluate the clinical outcomes of vacuum-assisted closure (VAC) for deep sternal wound infection (DSWI) after pediatric cardiac surgery. Methods From February 2017 to February 2020,6 DSWI children aged under 7 years after median sternotomy underwent VAC.There were 4 boys and 2 girls with an average age of (2.18±1.85) years (15 days to 5 years) and an average body weight of (10.43±5.96)(3-19) kg.The underlying cardiac diseases included complete transposition of the great arteries (n=1),tetralogy of Fallot (n=2),double outlet of right ventricle (n=1),ventricular septal defect (n=1),TAPVC (n=1),1 case of neonatal patient,wound secretion culture positive (n=3)[including Staphylococcus aureus (n=1) and Staphylococcus epidermidis (n=2)].The reasons for selecting VAC were severe wound infection,excessive exudation,or poor compliance of not tolerating bedside dressing changes.Six cases underwent VAC at Day 7-20 post-operation.The specific procedure was as follows:opening original surgical incision until a full exposure of sternum,completely removing necrotic tissue,trimming a black foam dressing of the same size as incision,filling the surface of sternum and finally sealing wound with a film.The initial pressure was 50 mmHg.The treatment mode was continuous suction with a light-to-medium strength.For children aged over 5 years with massive,the pressure might be elevated to 75 mmHg.Daily volume and color of wound drainage were recorded.After the daily volume of drainage fluid became <10 ml,color turned serous and non-purulent and granulation was fresh.Wound debridement and suturing were performed and regular postoperative observations followed. Results None of them died during hospitalization.After a course of VAC for 5-7 days,wound exudate decreased markedly,color became pale,body temperature declined and white blood cell count gradually normalized.Six cases returned to operating room for wound debridement.In 5 cases,a second debridement was successful and sternum preserved.In another case,due to late infection time and severe sternal necrosis,infection recurred after debridement and debridement was repeated with major muscle flap transfer.All 6 children were cured and discharged.During VAC,there were no complications such as active bleeding or circulatory fluctuation.There was no complaint of wound pain. Conclusion VAC is both safe and effective for deep sternal wound infection after median sternotomy after pediatric cardiac surgery.
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Memo
收稿日期:2020-05-10。
基金项目:十三五国家重点研发计划（编号：2017YFC1308100）
通讯作者:李守军,Email:drlishoujunfw@163.com