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CURRENT ISSUEACTA VULNOLOGICA

A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers


Official Journal of the Italian Association for Cutaneous Ulcers
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Acta Vulnologica 2006 September;4(3):129-34

language: Italian

Vacuum-assisted sternal closure after a “depression induced ischaemic test” in a case of severe mediastinitis

Cappuccio G. 1, Patanè F. 2, Comoglio C. 2, Zingarelli E. 2, Sansone F. 2, Ceresa F. 2, Valesio R. 1, Mazzucco G. 1, Rinaldi M. 2

1 Unità Operativa di Riabilitazione Cardiovascolare Casa di Cura Villa Serena, Piossasco, Torino
2 Divisione di Cardiochirurgia Ospedale di S. Giovanni Battista - Molinette, Torino


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The sternotomy wound infection evolving in mediastinitis represents a serious and expensive complication of the cardio surgical operations. Especially when there are various risk factors as diabetes, obesity and bilateral removal of the mammary arteries one may witness the appearance of mediastinitis hard to remove with the classic medico surgical techniques: the serious multi-organic compromised clinical situation resulting from the septic picture joins itself to an increase of the death and morbidity rate of the patient. We hereby propose the case of a 72 year old patient subject to a cardio surgical operation of total arterial myocardial revascularization with the onset during the post-operative period of diastasis of the sternal wound with evolution in mediastinis. The patient underwent a double mediastinic treatment needing the complete removal of the sternum. Seen the ineffectiveness of the two surgical treatments and the serious dehiscence outline of the wound with external exposure of the pericardial cavity and the grafts and despite this is considered generally as a complete contraindication for using the VAC therapy, we decided to use it all the same after having carried out a “Depression induced Ischemic Test” (DIIT) in order to evaluate the ischemic threshold. After 70 days of VAC Therapy and 20 of advanced medications, the lesion appeared clean and granulose, ready to heal. Therefore we think that Vac-Therapy may be used even in all those cases in which there is exposure of the pericardial cavity and the grafts. This kind of therapeutic approach has allowed us to reduce the postoperative stay in hospital, of allowing cicle of cardiac rehabilitation despite the severe complication, of improving the patient’s functional recovery.

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