Vacuum-assisted wound closure with instillation followed by nitinol clips application to treat deep sternal wound infections after cardiac surgery- evolution of a two-step approach

Introduction: DSWI, or mediastinitis, is a life-threatening complication following cardiac surgery. Although infrequent, it can cause significant morbidity and mortality, often requires multiple procedures, and increases health care costs. Different treatment approaches have been used. Objective: This article compares closed catheter irrigation with the currently used 2-stage approach using a proprietary vacuum-assisted wound closure with instillation system followed by sternal synthesis with nitinol clips. Materials and methods: The records of 34 patients with DSWI who underwent cardiac surgery between January 2012 and December 2020 were retrospectively analyzed. Patients received either closed catheter irrigation or vacuum-assisted wound closure with instillation for decontamination and subsequent closure with pectoralis major flaps (with or without the modified Robicsek technique), or more recently, with nitinol clips. Results: Wound healing was achieved in all patients treated with vacuum-assisted wound closure with instillation. In this group, no patients died and the mean hospital stay was reduced. Conclusions: These findings suggest that use of vacuum-assisted wound closure with instillation along with nitinol clips for sternal closure decreases mortality and reduces the length of hospital stay, making it a safer, effective, and less invasive technique for the management of DSWI after cardiac surgery.