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Vacuum-Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single-Center Experience

机译：儿科心脏手术中纵隔炎的真空辅助闭合：单中心体验

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Vacuum-assisted closure (VAC) has been widely used to treat mediastinitis after congenital cardiac surgery, which is associated with a high risk of morbidity and mortality. The aim in this study is to review our 14 cases of mediastinitis treated with VAC therapy after congenital cardiac surgery. We retrospectively reviewed the medical records of 14 congenital heart patients with mediastinitis from January 2012 to March 2017. Patients with fever, wound discharge, sternal dehiscence, a positive wound culture or abscess diagnosed with computed tomography are accepted as mediastinitis. A VAC was applied to all our patients without irrigation or dressing the wound because of sterility concerns. The vacuuming of the wound was either 50 mm Hg or 75 mm Hg according to the sternal intactness. We gradually decreased the pressures and changed the VAC systems once every three days, after wound healing was seen and a negative culture was obtained and VAC was terminated. There were 14 patients (8 male and 6 female) with mediastinitis and all of them were treated using VAC. The mean age of the patients was 6.96 months (ranging from 0.5-26 months). The mean weight was 5.16 kg (2.8-12 kg). Three patients needed extracorporeal membrane oxygenation after the surgery. Mean onset of mediastinitis was 25.3 days. The wound cultures showed methicillin resistant coagulase negative streptococcus and methicillin-sensitive staphylococcus aureus in most cases. Acinetobacter, serratia, pseudomonas, and klebsiella were the other bacterial species seen in cultures. Two patients had mediastinitis symptoms, but their cultures were negative. VAC systems were changed 3.85 times on average. Mean duration of hospital stay was 49.9 days (21-104 days). One patient needed a muscle flap to close the thoracic cavity after mediastinitis. Two patients did not survive. Mediastinitis is a serious postoperative condition in pediatric cardiac surgery patients. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group. Therefore, VAC therapy can be an effective way to successfully treat the situation.
机译：真空辅助封闭（VAC）已被广泛用于治疗先天性心脏手术后的纵隔炎，其与发病率和死亡率的高风险有关。本研究的目的是审查我们在先天性心脏手术后用VAC治疗治疗的14例纵隔炎。我们回顾性从2012年1月到2017年3月审查了14例先天性心脏患者的病历。发热，伤口排出，胸骨裂开，患有计算机断层扫描的阳性伤害或脓肿患者被认为是纵隔炎。由于无菌问题，VAC适用于所有患者而没有灌溉或梳理伤口。根据胸骨的抗性，伤口的吸尘是50mm Hg或75mm Hg。我们逐渐降低压力并每三天改变一次VAC系统，在伤口愈合后，获得了阴性培养物并终止了VAC。有14名患者（8名男性和6名女性），纵隔炎和所有患者使用VAC治疗。患者的平均年龄为6.96个月（范围从0.5-26个月）。平均重量为5.16千克（2.8-12千克）。三名患者手术后需要体外膜氧合。含有含有氨基炎的平均发病是25.3天。伤口培养物在大多数情况下显示出耐甲氧胞蛋白抗性凝固酶阴性链球菌和甲氧西林敏感的葡萄球菌。术治疗术，血清杆菌和克里斯氏菌是培养物中的其他细菌种类。两名患者有纵隔型症状，但他们的培养物是阴性的。 VAC系统平均更改了3.85倍。住院住院的平均持续时间为49.9天（21-104天）。一名患者需要肌肉皮瓣以在纵隔炎后闭上胸腔。两名患者没有生存。纵隔炎是儿科心脏手术患者的严重术后病症。古典伤口敷料和灌溉方法不适用于儿科年龄组的纵隔炎。因此，VAC治疗可以是成功治疗情况的有效途径。

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