Vacuum-assisted closure therapy for the management of deep sternal wound complications: A systematic review and meta-analysis

Neophytos Christodoulou; Brandon Wolfe; David W Mathes; Rafael D Malgor; Christodoulos Kaoutzanis

doi:10.1016/j.bjps.2023.09.049

Vacuum-assisted closure therapy for the management of deep sternal wound complications: A systematic review and meta-analysis

J Plast Reconstr Aesthet Surg. 2023 Oct 17:S1748-6815(23)00628-9. doi: 10.1016/j.bjps.2023.09.049. Online ahead of print.

Authors

Neophytos Christodoulou¹, Brandon Wolfe², David W Mathes³, Rafael D Malgor⁴, Christodoulos Kaoutzanis⁵

Affiliations

¹ Royal Papworth Hospital, Papworth Rd, Trumpington, Cambridge, UK.
² School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
⁴ Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, Colorado, United States.
⁵ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. Electronic address: ckaoutzanis@gmail.com.

PMID: 37951723
DOI: 10.1016/j.bjps.2023.09.049

Abstract

Background: Vacuum-assisted closure (VAC) therapy has become a popular treatment option for wound healing. The aim of this meta-analysis was to assess the use of VAC therapy as a bridge before the definitive treatment for the management of deep sternal wound complications.

Methods: A systematic literature review and meta-analysis were performed in PubMed and Embase. Outcomes of interest included mortality, treatment failure, length of hospital stay (LOS), length of intensive care unit (ICU) stay and cost of treatment.

Results: Twenty-two studies involving 1980 patients were included in the quantitative synthesis of this meta-analysis. Patients treated with VAC had significantly lower overall mortality [1738 patients; Risk ratio [RR] = 0.36 (95% confidence interval [CI]: 0.25, 0.51)], treatment failure [1210 patients; RR = 0.26 (95% CI: 0.19, 0.37)], LOS [498 patients; (standard mean difference = -0.44 (95% CI: -0.81, -0.07)] and ICU stay [309 patients; (standard mean difference = -0.34 (95% CI: -0.67, -0.01)] compared to that of non-VAC patients. VAC therapy was associated with reduced cost of treatment per patient compared with that of non-VAC therapies (reductions of 3600 USD, 6000 USD and 8983 USD in the reported studies).

Conclusions: VAC therapy as an adjunct in the definitive treatment of patients with deep sternal wound complications was associated with lower mortality, treatment failure, LOS, ICU stay and cost of treatment when compared with a non-VAC approach. Randomised controlled trials would be essential to confirm these findings.

Keywords: Deep sternal wound complications; Mediastinitis; Osteomyelitis; Sternal dehiscence; Vacuum-assisted closure.

Publication types

Review