Contraindications for the use of vacuum-assisted closure devices

Introduction: Vacuum-assisted closure (VAC) of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation is proofed. No contraindications for the use in deep sternal wounds in cardiac surgery are described. Methods: 21 patients (15 men, 6 women; median age of 64.4 years; mean BMI 36) with sternal wound infection after cardiac surgery (CABG n=18; AVR n=3) were treated with the VAC system (negative pressure 125mmHg) as a second choice after primary surgical debridement and reconstructive surgery with a pectoralis muscle flap. Results: Complete healing was not achieved in all patients (n=9). The VAC system was removed after a mean of 31.5 days (range 12 to 91 days). Two patients developed a severe bleeding from the ascending aorta and right ventricle by penetration of wire fragments in the tissue. Conclusions: The VAC system can be used in patients as an treatment for the therapy of sternal wound infections after cardiac surgery in the absence of wire fragments. The steel particles have to been removed completely before negative pressure is used.