초록접수 현황
| 16F-097 | 포럼 발표 |
Routine use of Vacuum-assisted Closure in Children with Sternal Wound Dehiscence: A 10-year Experience
Yeong Jeong Jeon, Yang Hyun Cho, Dong Seop Jeong, Kiick Sung, Wook Sung Kim, Young Tak Lee, Pyo Won Park, Tae-Gook Jun, Ji-Hyuk Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : Although sternal wound infection is a serious complication, there is a little treatment option for children. We have applied vacuum-assisted closure (VAC) to children with sternal wound dehiscence even though they are neonates. The purpose of this study is to evaluate the outcome.
Methods : From 2006 to 2016, 3827 pediatric cardiac procedures involving median sternotomy were performed at our institution. Among them, 60 (1.6%) consecutive patients with sternal wound dehiscence were managed with VAC. The VAC was applied immediately after wound opening. Sternum was left closed and VAC changed every 2 or 3 days with microbiologic culture. After negative conversion of microbiologic culture and appearance of well-vascularized surrounding tissue, the wound was closed primarily.
Results : The median age at the sternotomy prior to VAC was 21 days (range, 1 day ~ 3.7 years). Sternal wound dehiscence was found at median 7 (range, 4 ~ 30) days after surgery. In 43% (26/60) of the patients, microbiologic culture was positive. The most common causative organism was methicillin-resistant coagulase-negative Staphylococcus (n=7). In 92% (55/60) of the patients, wounds were successfully managed only with primary closure after the median 13 (range, 3 ~ 58) days of VAC. An additional procedure was required in 4 patients including 3 sternal rewiring and 1 pectoralis major muscle flap. One patient died of sepsis associated with intractable chylothorax before wound closure. Three patients died in hospital after wound closure due to necrotizing enterocolitis (n=2), respiratory failure (n=1). All survivors were discharged at median 35 (19 ~ 95) days after initial sternotomy.
Conclusion : VAC can be a safe option for the treatment of sternal wound dehiscence even in neonates and may reduce the need for additional surgical procedure.
Methods : From 2006 to 2016, 3827 pediatric cardiac procedures involving median sternotomy were performed at our institution. Among them, 60 (1.6%) consecutive patients with sternal wound dehiscence were managed with VAC. The VAC was applied immediately after wound opening. Sternum was left closed and VAC changed every 2 or 3 days with microbiologic culture. After negative conversion of microbiologic culture and appearance of well-vascularized surrounding tissue, the wound was closed primarily.
Results : The median age at the sternotomy prior to VAC was 21 days (range, 1 day ~ 3.7 years). Sternal wound dehiscence was found at median 7 (range, 4 ~ 30) days after surgery. In 43% (26/60) of the patients, microbiologic culture was positive. The most common causative organism was methicillin-resistant coagulase-negative Staphylococcus (n=7). In 92% (55/60) of the patients, wounds were successfully managed only with primary closure after the median 13 (range, 3 ~ 58) days of VAC. An additional procedure was required in 4 patients including 3 sternal rewiring and 1 pectoralis major muscle flap. One patient died of sepsis associated with intractable chylothorax before wound closure. Three patients died in hospital after wound closure due to necrotizing enterocolitis (n=2), respiratory failure (n=1). All survivors were discharged at median 35 (19 ~ 95) days after initial sternotomy.
Conclusion : VAC can be a safe option for the treatment of sternal wound dehiscence even in neonates and may reduce the need for additional surgical procedure.
책임저자: Ji-Hyuk Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Yeong Jeong Jeon, E-mail : yj.yj.jeon@samsung.com