A New Technique for the Treatment of Delayed Sternotomy Healing: The Vacuum Therapy


  • Roland G. Demaria
  • Uberto Giovannini
  • Luc Téot
  • Jean-Marc Frapier
  • Bernard Albat




Background: The treatment of nonhealing and infected sternotomies after cardiac surgery is a challenging task, with its increased rates of mortality, morbidity, and costs. Local vacuum therapy (V.A.C. system) allows treatment of local infections, thanks to continuous aspiration and the sealed dressing that stimulates granulation tissue formation. The purpose of this clinical investigation was to evaluate vacuum therapy in cardiac surgery for achieving healing of delayed sternotomy closure after cardiac surgery.

Materials and Methods: From January 1998 to December 2002, 7 patients who underwent coronary artery bypass surgery under cardiopulmonary bypass by median sternotomy approaches presented a nonhealing infected sternal surgical wound that was treated with local vacuum therapy. Aspiration maintained between -125 mm Hg and -200 mm Hg was carried out on the entire surface of the wound with a sponge connected hermetically to an aspiration system. The treatment was associated with antibiotic therapy adapted to the results of bacteriological studies of the aspirates.

Results: All patients with delayed sternotomy closure healed in approximately 8 weeks (2-12 weeks) with the exception of one patient who died of multiorgan failure after a satisfactory muscular pectoral flap. Treatment was possible with vacuum therapy alone (n = 2), with vacuum therapy in association by second intention with a skin graft (n = 1), or both with a muscular pectoral flap (n = 4). Sternal stability appears to be an important factor for achieving satisfactory and complete healing.

Conclusions: This new therapy offers an alternative to the classic treatment of infected sternotomies in cardiac surgery, especially in preparing rewiring and muscular flaps for complicated cases with sternal instability or alone. The treatment must be instituted early to be more effective.


Lauwers S, de Smet F. 1998. Surgical site infections. Acta Clin Belg 53:303-10.nLizan-Garcia M, Garcia-Caballero J, Asensio-Vegas A. 1997. Risk factors for surgical-wound infection in general surgery: a prospective study. Infect Control Hosp Epidemiol 18:310-5.nMorykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. 1997. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553-62.nMullner T, Mrkonjic L, Kwasny O, Vecsei V. 1997. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg 50:194-9.nObdeijn MC, de Lange MY, Lichtendahl DH, de Boer WJ. 1999. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. Ann Thorac Surg 68:2358-60.nTang ATM, Ohri SK, Haw MP. 2000. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 17:482-4.nEvans D, Land L. 2001. Topical negative pressure for treating chronic wounds: a systematic review. Br J Plast Surg 54:238-42.nGiovannini UM, Demaria RG, Chaptal PA, Téot L. 2001. Negative pressure for the management of an exposed vascular Dacron polyester patch. Ann Plast Surg 47:577-8.nGiovannini UM, Demaria RG, Téot L. 2001. Interest of negative pressure therapy in the treatment of postoperative sepsis in cardiovascular surgery. Wounds 13:82-7.nGreer SE, Longaker MT, Margiotta M, Mathews AJ, Kasabian A. 1999. The use of subatmospheric pressure dressing for the coverage of radial forearm free flap donor-site exposed tendon complications. Ann Plast Surg 43:551-4.nHartnett JM. 1998. Use of vacuum-assisted wound closure in three chronic wounds. J Wound Ostomy Continence Nurs 25:281-90.nKalailieff D. 1998. Vacuum-assisted closure: wound care technology for the new millennium. Perspectives 22:28-9.nKucan JO, Robson MC, Heggers JP, Ko F. 1981. Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers. J Am Geriatr Soc 29:232-5.nAlvarez AA, Maxwell GL, Rodriguez GC. 2001. Vacuum-assisted closure for cutaneous gastrointestinal fistula management. Gynecol Oncol 80:413-6.nArgenta LC, Morykwas MJ. 1997. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563-76.nBucalo B, Eaglstein WH, Falanga F. 1993. Inhibition of cell proliferation by chronic wound fluid. Wound Repair Regen 1:181-6.nDemaria R, Giovannini UM, Vidal R, et al. 2000. Le Vacuum Assisted Closure (V.A.C.): un nouvel instrument de cicatrisation dirigée sous vide pour les retards de cicatrisation en chirurgie cardiovasculaire. J Chir Thorac Cardio-Vasc IV:141-4.nDemaria R, Giovannini U, Téot L, et al. 2001. Using VAC to treat a vascular bypass site infection. J Wound Care 10:12-3.nDoss M, Martens S, Wood JP, Wolff JD, Baier C, Moritz A. 2002. Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiothorac Surg 22:934-8.n



How to Cite

Demaria, R. G., Giovannini, U., Téot, L., Frapier, J.-M., & Albat, B. (2005). A New Technique for the Treatment of Delayed Sternotomy Healing: The Vacuum Therapy. The Heart Surgery Forum, 6(5), 434-437. https://doi.org/10.1532/hsf.599