Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Abstract

Background: Deep sternal wound infection (DSWI) or mediastinitis is a severe and life-threatening infection with high morbidity and mortality rates. Vacuum-assisted closure (VAC) provides good results and is very useful in wound closure. VAC therapy is a safe and affordable method for managing complex sternal and thoracic injuries. The use of VAC has been shown to increase parasternal blood flow by dilating arterioles, reducing bacterial load, and accelerating granulation tissue formation. It also helps with facilitating wound edge closure. Case and Operation Technique: A 6-month-old baby presented with an ulcer 2 cm deep in the thorax region. The wound had an exposed bone surrounded by slough and hyperemic edges. Bone destruction was seen to have reached the costochondral joint with a gross visible appearance of the pleura. Management of this patient included debridement, sternotomy, internal fixation of the sternum using the Robiscek technique, and application of the Water Shield Drainage (WSD) and VAC. The tobacco-sack technique was used to close the open wound. The Robiscek technique was used in this patient because of the bone destruction to the costochondral joints causing the sternum to become unstable. The VAC dressing was then connected to a suction with an intermittent negative pressure of 75mmHg. After a significant decrease in the wound surface area, a local rotational flap was used to close the wound. Conclusion: The use of modified VAC for deep sternal wound infection (DSWI) is effective, simple, and affordable with minimal complications.

Using of Negative Wound Pressure Therapy (Npwt): a Case Series of Wound Disruption as a Complication of a Caesarean Section

“…Furthermore, the use of VAC enhances patient and nursing staff comfort compared to traditional dressings, reducing the frequency of dressing changes, fluid leakage, and wound odor. 14,17 Despite potentially higher initial costs, the overall treatment cost using VAC is comparable to modern dressings. The longterm benefits of VAC therapy include accelerated healing, reduced complications, and minimized hospitalization time, making it a cost-effective option for wound management.…”