Although, many studies and trials have demonstrated benefits of using VAC therapy in deep sternal wound infections, conclusive evidence is still lacking regarding its effectiveness in this particular setting. …
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The impact of VAC Therapy on management of sternal wound infections after cardiac surgery
Sternal wound infection after cardiac surgery is a serious problem resulting in increased patient morbidity; mortality and duration of hospital stay (Luckraz et al 2003).
The incidence of this infection has been variably reported as 0.5 to 5% and the resultant mortality as 10 to 25% (Sjogren et al 2006; Schimer et al 2008). Conventionally, many management techniques have been recommended to treat this complication like surgical debridement with open dressings, closed irrigation of the infected wound, or reconstruction with vascularised omental or pectoral muscle flaps (Domkowski et al 2003). Vacuum assisted closure (VAC) therapy is one of the newer modalities to treat this complication (Evans & Land 1997) which has been widely adopted. Application of negative pressure was successfully used for treating chronic wounds such as diabetic foot ulcers (Eneroth & van Houtum 2008; Ubbink et al 2008). After it was found successful in achieving faster healing in these wounds, use of this therapy has been extended for the management of sternal wound infections as well (Luckraz et al 2003; Domkowski et al 2003; Hersh et al 2003; Sjogren et al 2006). However, it hasn’t been proven yet with good evidence that its efficacy is more than the conventional treatment. Thus, the main objective of this review is to determine the effectiveness of vacuum assisted closure therapy in the management of wound infection after cardiac surgery.
Also, it allows re-examination of the wound and bedside debridement, as and when required. To apply negative pressure, wound area is packed with special dressing (polyurethane sponge/foam or polyvinyl alcohol foam) and covered with a transparent tape which seals the wound. A drain tube passes through this tube which is connected to a vacuum tube which sucks out the fluid through this drain tube. Negative pressure applied is in the range of -75 to -125 mm Hg (MAS 2006). Conventionally, medical (antibiotics) and various surgical modalities have been used in the treatment of deep sternal wound infections (DSWI) (Singh, Anderson & Harper 2011). Surgical management options include closed suction antibiotic irrigation system, omental flap reconstruction, pectoralis major, latissimus dorsi or rectus abdominis muscle advancement or rotation flap, and microsurgical free flap. Early wound exploration is combined with any of these techniques. Regimen of sternal fixation with sternal plating system is also getting popular (Singh, Anderson & Harper 2011). Traditional methods of wound care involve regular cleaning and dressing of the wound different kinds of dressing materials from simple gauzes to chemical impregnated gauzes as per the type of the wound. However, VAC therapy is being projected as one solution for multiple wound types. Search strategy A manual search was conducted for the journals, books and other data related to the subject. Internet was also accessed for searching for journal articles pertaining to the subject. CINAHL database via the EBSCO host platform was utilized to perform a literature search because it is the most wide-ranging nursing database and is easy to search. MEDLINE and COCHRANE database
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22 Pages(5500 words)Literature review
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