Kyle Northcote Cowan, MD, PhD, Laura Teague, RN, MN, Sammy C

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Vacuum-Assisted Wound Closure of Deep Sternal Infections in High-Risk Patients After Cardiac Surgery Kyle Northcote Cowan, MD, PhD, Laura Teague, RN, MN, Sammy C. Sue, BS, James L. Mahoney, MD The Annals of Thoracic Surgery Volume 80, Issue 6, Pages 2205-2212 (December 2005) DOI: 10.1016/j.athoracsur.2005.04.005 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Evidence of and bacteria colonizing sternal wound infections. (a) Graphical summary of the frequency with which various signs, symptoms, imaging of fluid collections, and biopsy indicative of osteomyelitis were reported in patients with mediastinitis. (b) Frequency of colonization of sternal wounds by various bacterium, and summarized graphically. (Bars = n of 22, and are not mutually exclusive; Coag Neg Staph. = coagulase negative Staphylococcus; CT = computed tomography; E. faecalis = Escherichia faecalis; S. aureus = Staphylococcus aureus.) The Annals of Thoracic Surgery 2005 80, 2205-2212DOI: (10.1016/j.athoracsur.2005.04.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Changes in sternal wound size with the application of vacuum-assisted closure (VAC) therapy. (a–c) Photographs of a representative sternal wound after debridement, but (a) before VAC application, (b) after 2 weeks of VAC therapy, and (c) at completion of VAC therapy. (d) Graphical summary of mean changes in wound size in the 22 study patients. Bars represent mean ± SD with n = 22. *p < 0.05 compared with wound size before VAC application. The Annals of Thoracic Surgery 2005 80, 2205-2212DOI: (10.1016/j.athoracsur.2005.04.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Management algorithm for deep sternal wound infections. The schematic details, in a stepwise fashion, the management of deep sternal wound infections at our institution. This process flows from initial presentation through assessment and establishing the presence of mediastinitis to treatment options, including standard therapies and vacuum-assisted closure (VAC) application. This process also highlights the patient population in whom we did not use VAC as well as the process by which we monitored improvements under VAC therapy and the resultant treatment options based upon those assessments. (CT = computed tomography.) The Annals of Thoracic Surgery 2005 80, 2205-2212DOI: (10.1016/j.athoracsur.2005.04.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions