Management of Deep Sternal Wound Infections: Open Dressing versus Vacuum Assisted Closure Device Therapy - An Institutional Experience

We present an ambispective analysis of the Management of Deep Sternal Wound Infections: Open Dressing versus Vacuum Assisted Closure Device Therapy at our Institute. Aim: The aim of our study is to compare and analyse our experience of Management of Deep Sternal Wound Infections with Open Dressing and Vacuum Assisted Closure Device Therapy and outcome. Methods: We analysed and compared our data ( Group I) from 01 May 2009 to 31 May 2012 when the modality of management of DSWI was open dressings and irrigation (ie; Pre-VAC era at our institute) with data (Group II) from 01 May 2013 to 31 Apr 2017 when the modality of management of DSWI was changed to Vacuum Assisted Closure Device Therapy.2228 patients underwent sternotomies from 01 May 2009 to 31 May 2012 and 2168 patients underwent sternotomies from 01 May 2013 to 31 Apr 2017. In Group I postoperative DSWI was diagnosed in 22 patients There were 14 (63.63 %) Males aged 45 to 81 years and 08 (36.37 %) Females aged 43 to 71 years. and in Group II postoperative DSWI was diagnosed in 20 patients. There were 11 (55 %) Males, aged 39 to 74 years and 09 (45 %) Females, aged 44 to 66 years. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student�s test and Fisher�s exact test. Results: In Group I - 17 (77.27 %) patients underwent Secondary suturing with tension bands and 01 (4.5 %) patient required flap cover to cover the defect. The mortality was 04 (18.18 %) ( 03 Male and 01 Female), whereas in Group II- 16 (80 %) patients underwent Secondary suturing with tension bands and 02 (10 %) patient required flap cover to cover the defect. The mortality was 02 (10 %) ( 01 Male and 01 Female). Conclusion: As compared to open dressings and irrigation, VAC therapy is safe and reliable option in Deep sternal wound infection after cardiac surgery, with excellent survival and low failure rate. VAC reduces mortality, increases sternal stability, patient comfort and can be used in any Hospital. Pre-operative Diabetes Mellitus, Renal Failure and Obesity are risk factors for mortality in patients treated with both modalities.