Aim: Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies.Methods: From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superfi cial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m 2 (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %).Results: Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to defi nite wound closure. Three patients (9 %) with chronic fi stula were re-admitted 1 to 6 months after VAC therapy.Conclusions: VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an eff ective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.

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Aim.To compare assessment of fibrinogen by thromboelastography with the standard von Clauss method. Methods. Observational prospective study. Results. Thromboelastography provides direct and complex evaluation of the entire coagulation cascade based upon changes in blood viscosity. It affects both platelets and plasma components. New application of this method measures fibrinogen contribution to coagulation as opposed to fibrinogen antigen levels measured by immunoassay. Paired samples from 117 patients before cardiopulmonary bypass were compared. A moderate correlation was found between fibrinogen and functional fibrinogen with a Spearman correlation coefficient of 0.476. Conclusion. The functional fibrinogen test is a valid point-of-care method for fibrinogen assay with a moderate correlation to the standard method.

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Great saphenous vein harvest is associated with a significant risk of impaired wound healing. The purpose of this study was to determine efficacy of one system designed for minimally invasive vein harvest (MIVH) and to assess postoperative and mid-term wound-healing disturbances. From February 2004 to June 2005, great saphenous harvest for coronary artery bypass grafting (CABG) was performed in a group of 120 consecutive patients employing the VEGA system (B/Braun-Aesculap, Tuttlingen, Germany). Patients were evaluated on 7th postoperative day, at the 3-month and 1-year follow-up for wound healing disturbances, residual leg edema, and saphenous neuropathy. The mean age was 67.3 years, male patients dominated (70%), and the leading procedure was CABG (83%). The mean number of harvested venous grafts was 1.9 +/- 1.2 and the mean number of skin incisions was 3.7 +/- 2.2. The mean total vein harvesting time was 40.2 +/- 16.8 minutes. Satisfactory healing was achieved in 98% patients on 7th postoperative day and at the 3-month follow-up all wounds were completely healed. Saphenous neuralgia remained a significant cause of morbidity, although its incidence decreased from 25% presented on 7th postoperative day to 8% presented at 1-year follow-up. Likewise, the incidence of leg edema decreased from 34% on the 7th postoperative day to 7% at 1-year follow-up. Minimally invasive vein harvest is a safe method associated with a significant reduction of wound disturbances. The VEGA system appears to be suitable and effective equipment for MIVH. Nevertheless, residual edema and mainly saphenous neuropathy represent a relatively frequent cause of patient morbidity at the postoperative and mid-term follow-up.

Úvod: V koronární chirurgii pfiedstavuje endoskopick˘ odbûr vena saphena magna moderní techniku, která pfii zachování kvality získaného Ïilního ‰tûpu v˘znamnû sniÏuje v˘skyt ran˘ch a neurologick˘ch komplikací, ve srovnání s tradiãní technikou odbûru vena saphena magna (VSM). Metody: Endoskopick˘ odbûr vena saphena magna (EVH) byl proveden u 100 nemocn˘ch indikovan˘ch k chirurgické revaskularizaci myokardu v období ãervenec 2005 aÏ bfiezen 2006. K odbûru bylo pouÏito instrumentárium Vasoview 6™ (Guidant Europe S. A., Belgie). V souboru byla prospektivnû hodnocena incidence ran˘ch a neurologick˘ch komplikací a reziduálních otokÛ po EVH v ãasovém údobí 7. pooperaãního dne a tfii mûsíce po chirurgickém v˘konu. V˘sledky: Stfiední vûk v souboru byl 68,9 ± 10,2 roku, muÏi dominovali (68 %) a u 67 nemocn˘ch (67 %) byl pfiítomen minimálnû jeden rizikov˘ faktor rozvoje ran˘ch komplikací spojen˘ch s odbûrem vena saphena magna. PrÛmûrn˘ poãet odebran˘ch Ïilních ‰tûpÛ byl 2,2 ± 1,2 a prÛmûrn˘ odbûrov˘ ãas byl 40,2 ± 8,3 minut. Konverze na tradiãní odbûr vena saphena magna byla nutná u dvou nemocn˘ch (2 %). Pfii hodnocení se vyskytoval 7. pooperaãní den ran˘ hematom u 46 nemocn˘ch (46 %). Nebyly zaznamenány Ïádné jiné rané komplikace. U ‰esti nemocn˘ch (6 %) se vyskytly neurologické komplikace v distální inervaãní zónû nervus saphenus. Reziduální otok dolní konãetiny byl pfiítomen u 15 nemocn˘ch (15 %) a korespondoval s v˘skytem vût‰ích hematomÛ. Pfii hodnocení po tfiech mûsících od v˘konu nebyly zaznamenány Ïádné rané komplikace; u 7 nemocn˘ch (7 %) zÛstával otok konãetiny a u dvou nemocn˘ch (2 %) byly zaznamenány neurologické komplikace. Závûr: EVH v˘znamnû sniÏuje v˘skyt ran˘ch a neurologick˘ch komplikací spojen˘ch s odbûrem vena saphena magna. Odbûr je moÏno bezpeãnû provést i u nemocn˘ch s pfiítomností rizikov˘ch faktorÛ poruch hojení, jako jsou diabetes mellitus, ischemická choroba dolních konãetin, obezita ãi dlouhodobá imunosupresivní léãba. Kvalita Ïilních ‰tûpÛ a ãasová nároãnost odbûru je srovnatelná s tradiãní technikou odbûru VSM. Klíãová slova: Endoskopick˘ odbûr vena saphena magna-Odbûr vena saphena magna-Revaskularizace myokardu-Vasoview 6™

Aim. We sought to evaluate our experience with endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). Methods. From October 2005 to June 2010, 50 patients who underwent endoscopic radial artery harvesting for an elective CABG were prospectively assessed for harvesting characteristics, complications, postoperative and mid-term outcomes.Results. There were 34 (68%) males and 16 (32%) females, average age 60.8±9.2 years. All but two RA grafts (96%) were successfully harvested endoscopically. Mean harvesting time was 46.2±9.3 min and mean length of harvested grafts was 23.4±2.2 cm. In the post-operative period there were no wound-healing complications; residual forearm edema was recorded in 6 patients (12%) and peripheral neuropathy in 4 patients (8%). At 3 months after the surgery, peripheral neuropathy and residual edema persisted in 2 patients (4%). A significant drop of overall harvesting time (56.2± 18.6 vs. 38.6±8.6 min, P<0.05) and forearm ischemia time (41.8±12.7 vs. 24.2±3.2 min, P<0.01) was found between first and last ten cases in the group. Conclusion. Endoscopic radial artery harvesting was associated with low risk of post-harvesting complications and most of these disappeared within a 3 months follow-up. However, there was a significant learning curve.