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Richard Ingemansson - One of the best experts on this subject based on the ideXlab platform.

  • the cost of Vacuum Assisted Closure therapy in treatment of deep sternal wound infection
    Scandinavian Cardiovascular Journal, 2008
    Co-Authors: Arash Mokhtari, Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Jan Nilsson, Richard Ingemansson
    Abstract:

    Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with Vacuum-Assisted Closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.

  • mechanisms governing the effects of Vacuum Assisted Closure in cardiac surgery
    Plastic and Reconstructive Surgery, 2007
    Co-Authors: Malin Malmsjo, Richard Ingemansson, Johan Sjogren
    Abstract:

    Vacuum-Assisted Closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which Vacuum-Assisted Closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during Vacuum-Assisted Closure therapy. This article provides an overview of the effects of Vacuum-Assisted Closure on heart and lung function and summarizes the current knowledge on the mechanisms by which Vacuum-Assisted Closure therapy promotes wound healing.

  • hemodynamic effects of Vacuum Assisted Closure therapy in cardiac surgery assessment using magnetic resonance imaging
    The Journal of Thoracic and Cardiovascular Surgery, 2007
    Co-Authors: Rainer Petzina, Johan Sjogren, Richard Ingemansson, Martin Ugander, Lotta Gustafsson, Henrik Engblom, Roland Hetzer, Hakan Arheden, Malin Malmsjo
    Abstract:

    Objective The hemodynamic effects of Vacuum-Assisted Closure therapy in cardiac surgery are debated. The aim of the present study was to quantify cardiac output and left ventricular chamber volumes after Vacuum-Assisted Closure using magnetic resonance imaging, which is known to be the most accurate method for quantifying these measures. Methods Six pigs had median sternotomy followed by Vacuum-Assisted Closure treatment in the presence and absence of a paraffin gauze interface dressing. Cardiac output and stroke volume were examined using magnetic resonance imaging flow quantification (breath-hold and real-time). Chamber volumes were assessed using cine magnetic resonance imaging. Results Cardiac output and stroke volume decreased immediately after application of negative pressures of 75, 125, and 175 mm Hg (13% ± 1% decrease in cardiac output). Interposition of 4 layers of paraffin gauze dressing over the heart during Vacuum-Assisted Closure therapy resulted in a smaller decrease in cardiac output (8% ± 1%). Conclusions Vacuum-Assisted Closure therapy results in an immediate decrease in cardiac output, although to a lesser extent than shown previously. Covering the heart with a wound interface dressing lessens the hemodynamic effects of Vacuum-Assisted Closure.

  • Vacuum Assisted Closure of the sternotomy wound respiratory mechanics and ventilation
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Ronny Gustafsson, Johan Sjogren, Malin Malmsjo, Lars Algotsson, Angelica Wackenfors, Richard Ingemansson
    Abstract:

    Background:Numerous authors have reported promising results with the use of Vacuum-Assisted Closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with resp

  • the impact of Vacuum Assisted Closure on long term survival after post sternotomy mediastinitis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Johan Nilsson, Richard Ingemansson
    Abstract:

    Background Post-sternotomy mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after Vacuum-Assisted Closure treated mediastinitis following coronary artery bypass grafting with that of patients without mediastinitis. Another objective was to identify risk factors for developing mediastinitis. Methods Forty-six patients were treated for mediastinitis, with Vacuum-Assisted Closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for mediastinitis. Results There was no difference in early or late survival between the mediastinitis group treated with Vacuum-Assisted Closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the Vacuum-Assisted Closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing mediastinitis. Conclusions This study suggests that patients with Vacuum-Assisted Closure treated mediastinitis may have similar long-term survival as patients without mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that Vacuum-Assisted Closure therapy minimizes the negative effects of mediastinitis on late survival after coronary artery bypass grafting.

Ronny Gustafsson - One of the best experts on this subject based on the ideXlab platform.

  • the cost of Vacuum Assisted Closure therapy in treatment of deep sternal wound infection
    Scandinavian Cardiovascular Journal, 2008
    Co-Authors: Arash Mokhtari, Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Jan Nilsson, Richard Ingemansson
    Abstract:

    Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with Vacuum-Assisted Closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.

  • Vacuum Assisted Closure of the sternotomy wound respiratory mechanics and ventilation
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Ronny Gustafsson, Johan Sjogren, Malin Malmsjo, Lars Algotsson, Angelica Wackenfors, Richard Ingemansson
    Abstract:

    Background:Numerous authors have reported promising results with the use of Vacuum-Assisted Closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with resp

  • the impact of Vacuum Assisted Closure on long term survival after post sternotomy mediastinitis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Johan Nilsson, Richard Ingemansson
    Abstract:

    Background Post-sternotomy mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after Vacuum-Assisted Closure treated mediastinitis following coronary artery bypass grafting with that of patients without mediastinitis. Another objective was to identify risk factors for developing mediastinitis. Methods Forty-six patients were treated for mediastinitis, with Vacuum-Assisted Closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for mediastinitis. Results There was no difference in early or late survival between the mediastinitis group treated with Vacuum-Assisted Closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the Vacuum-Assisted Closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing mediastinitis. Conclusions This study suggests that patients with Vacuum-Assisted Closure treated mediastinitis may have similar long-term survival as patients without mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that Vacuum-Assisted Closure therapy minimizes the negative effects of mediastinitis on late survival after coronary artery bypass grafting.

  • clinical outcome after poststernotomy mediastinitis Vacuum Assisted Closure versus conventional treatment
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Johan Nilsson, Richard Ingemansson
    Abstract:

    Background. The conventional treatment for poststernotomy mediastinitis usually involves surgical revision, closed irrigation, or reconstruction with omentum or pectoral muscle flaps. Recently, Vacuum-Assisted Closure has been successfully used in poststernotomy mediastinitis. The aim of the present study was to compare the clinical outcome and survival in 101 patients undergoing Vacuum-Assisted Closure therapy or conventional treatment for poststernotomy mediastinitis. Methods. One hundred one consecutive patients underwent treatment for poststernotomy mediastinitis: Vacuum-Assisted Closure therapy (January 1999 through December 2003, n = 61) or conventional treatment (July 1994 through December 1998, n = 40). Follow-up was made in April 2004 and was 100% complete. Actuarial statistics were used to calculate the survival rates. Results. The 90-days mortality was 0% in the Vacuum-Assisted Closure group and 15% in the conventional treatment group (p < 0.01). The failure rate to first-line treatment with Vacuum-Assisted Closure and conventional treatment were 0% and 37.5%, respectively (p < 0.001). There was no statistically significant difference in the recurrence of sternal fistulas after Vacuum-Assisted Closure therapy or conventional treatment: 6.6% versus 5.0%, respectively. Overall survival in the Vacuum-Assisted Closure group was significantly better (p < 0.05) than in the conventional treatment group: 97% versus 84% (6 months), 93% versus 82% (1 year), and 83% versus 59% (5 years). Conclusions. Our findings support that Vacuum-Assisted Closure therapy is a safe and reliable option in poststernotomy mediastinitis with excellent survival and a very low failure rate compared with conventional treatment. (Less)

  • blood flow responses in the peristernal thoracic wall during Vacuum Assisted Closure therapy
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Angelica Wackenfors, Johan Sjogren, Ronny Gustafsson, Richard Ingemansson, Lars Algotsson, Malin Malmsjo
    Abstract:

    Background Vacuum-Assisted Closure (VAC) therapy is a recently introduced method for the treatment of poststernotomy mediastinitis. The aim of this study was to examine the effects of negative pressure on peristernal soft tissue blood flow and metabolism because the mechanisms by which Vacuum-Assisted Closure therapy promotes wound healing are not known in detail. Methods Microvascular blood flow was examined by laser Doppler velocimetry in an uninfected porcine sternotomy wound model. Microvascular blood flow was examined in the muscular and subcutaneous tissue, at different distances from the wound edge, after the application of −50 to −200 mm Hg. Wound fluid pH, partial pressures of oxygen and carbon dioxide, bicarbonate, and lactate were analyzed after 0, 30, and 60 minutes of continuous negative pressure. Results Vacuum-Assisted Closure therapy induced an increase in the microvascular blood flow a few centimeters from the wound edge. In muscular tissue, the distance from the wound edge to the position at which the blood flow was increased was shorter than that in subcutaneous tissue. Close to the wound edge, relative hypoperfusion was observed. The hypoperfused zone was larger at high negative pressures and was especially prominent in subcutaneous tissue. Wound fluid partial pressure of oxygen and lactate levels were increased after 60 minutes of Vacuum-Assisted Closure therapy, which may be the result of changes in the microvascular blood flow. Conclusions Vacuum-Assisted Closure therapy induces a change in microvascular blood flow that is dependent on the pressure applied, the distance from the wound edge, and the tissue type. It may be beneficial to tailor the negative pressure used for Vacuum-Assisted Closure therapy according to the wound tissue composition. Wound fluid partial pressure of oxygen and lactate levels increased during Vacuum-Assisted Closure therapy. This combination is known to promote wound healing.

Johan Sjogren - One of the best experts on this subject based on the ideXlab platform.

  • the cost of Vacuum Assisted Closure therapy in treatment of deep sternal wound infection
    Scandinavian Cardiovascular Journal, 2008
    Co-Authors: Arash Mokhtari, Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Jan Nilsson, Richard Ingemansson
    Abstract:

    Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with Vacuum-Assisted Closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.

  • mechanisms governing the effects of Vacuum Assisted Closure in cardiac surgery
    Plastic and Reconstructive Surgery, 2007
    Co-Authors: Malin Malmsjo, Richard Ingemansson, Johan Sjogren
    Abstract:

    Vacuum-Assisted Closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which Vacuum-Assisted Closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during Vacuum-Assisted Closure therapy. This article provides an overview of the effects of Vacuum-Assisted Closure on heart and lung function and summarizes the current knowledge on the mechanisms by which Vacuum-Assisted Closure therapy promotes wound healing.

  • hemodynamic effects of Vacuum Assisted Closure therapy in cardiac surgery assessment using magnetic resonance imaging
    The Journal of Thoracic and Cardiovascular Surgery, 2007
    Co-Authors: Rainer Petzina, Johan Sjogren, Richard Ingemansson, Martin Ugander, Lotta Gustafsson, Henrik Engblom, Roland Hetzer, Hakan Arheden, Malin Malmsjo
    Abstract:

    Objective The hemodynamic effects of Vacuum-Assisted Closure therapy in cardiac surgery are debated. The aim of the present study was to quantify cardiac output and left ventricular chamber volumes after Vacuum-Assisted Closure using magnetic resonance imaging, which is known to be the most accurate method for quantifying these measures. Methods Six pigs had median sternotomy followed by Vacuum-Assisted Closure treatment in the presence and absence of a paraffin gauze interface dressing. Cardiac output and stroke volume were examined using magnetic resonance imaging flow quantification (breath-hold and real-time). Chamber volumes were assessed using cine magnetic resonance imaging. Results Cardiac output and stroke volume decreased immediately after application of negative pressures of 75, 125, and 175 mm Hg (13% ± 1% decrease in cardiac output). Interposition of 4 layers of paraffin gauze dressing over the heart during Vacuum-Assisted Closure therapy resulted in a smaller decrease in cardiac output (8% ± 1%). Conclusions Vacuum-Assisted Closure therapy results in an immediate decrease in cardiac output, although to a lesser extent than shown previously. Covering the heart with a wound interface dressing lessens the hemodynamic effects of Vacuum-Assisted Closure.

  • Vacuum Assisted Closure of the sternotomy wound respiratory mechanics and ventilation
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Ronny Gustafsson, Johan Sjogren, Malin Malmsjo, Lars Algotsson, Angelica Wackenfors, Richard Ingemansson
    Abstract:

    Background:Numerous authors have reported promising results with the use of Vacuum-Assisted Closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with resp

  • the impact of Vacuum Assisted Closure on long term survival after post sternotomy mediastinitis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Johan Nilsson, Richard Ingemansson
    Abstract:

    Background Post-sternotomy mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after Vacuum-Assisted Closure treated mediastinitis following coronary artery bypass grafting with that of patients without mediastinitis. Another objective was to identify risk factors for developing mediastinitis. Methods Forty-six patients were treated for mediastinitis, with Vacuum-Assisted Closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for mediastinitis. Results There was no difference in early or late survival between the mediastinitis group treated with Vacuum-Assisted Closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the Vacuum-Assisted Closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing mediastinitis. Conclusions This study suggests that patients with Vacuum-Assisted Closure treated mediastinitis may have similar long-term survival as patients without mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that Vacuum-Assisted Closure therapy minimizes the negative effects of mediastinitis on late survival after coronary artery bypass grafting.

Malin Malmsjo - One of the best experts on this subject based on the ideXlab platform.

  • the cost of Vacuum Assisted Closure therapy in treatment of deep sternal wound infection
    Scandinavian Cardiovascular Journal, 2008
    Co-Authors: Arash Mokhtari, Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Jan Nilsson, Richard Ingemansson
    Abstract:

    Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with Vacuum-Assisted Closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.

  • mechanisms governing the effects of Vacuum Assisted Closure in cardiac surgery
    Plastic and Reconstructive Surgery, 2007
    Co-Authors: Malin Malmsjo, Richard Ingemansson, Johan Sjogren
    Abstract:

    Vacuum-Assisted Closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which Vacuum-Assisted Closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during Vacuum-Assisted Closure therapy. This article provides an overview of the effects of Vacuum-Assisted Closure on heart and lung function and summarizes the current knowledge on the mechanisms by which Vacuum-Assisted Closure therapy promotes wound healing.

  • hemodynamic effects of Vacuum Assisted Closure therapy in cardiac surgery assessment using magnetic resonance imaging
    The Journal of Thoracic and Cardiovascular Surgery, 2007
    Co-Authors: Rainer Petzina, Johan Sjogren, Richard Ingemansson, Martin Ugander, Lotta Gustafsson, Henrik Engblom, Roland Hetzer, Hakan Arheden, Malin Malmsjo
    Abstract:

    Objective The hemodynamic effects of Vacuum-Assisted Closure therapy in cardiac surgery are debated. The aim of the present study was to quantify cardiac output and left ventricular chamber volumes after Vacuum-Assisted Closure using magnetic resonance imaging, which is known to be the most accurate method for quantifying these measures. Methods Six pigs had median sternotomy followed by Vacuum-Assisted Closure treatment in the presence and absence of a paraffin gauze interface dressing. Cardiac output and stroke volume were examined using magnetic resonance imaging flow quantification (breath-hold and real-time). Chamber volumes were assessed using cine magnetic resonance imaging. Results Cardiac output and stroke volume decreased immediately after application of negative pressures of 75, 125, and 175 mm Hg (13% ± 1% decrease in cardiac output). Interposition of 4 layers of paraffin gauze dressing over the heart during Vacuum-Assisted Closure therapy resulted in a smaller decrease in cardiac output (8% ± 1%). Conclusions Vacuum-Assisted Closure therapy results in an immediate decrease in cardiac output, although to a lesser extent than shown previously. Covering the heart with a wound interface dressing lessens the hemodynamic effects of Vacuum-Assisted Closure.

  • Vacuum Assisted Closure of the sternotomy wound respiratory mechanics and ventilation
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Ronny Gustafsson, Johan Sjogren, Malin Malmsjo, Lars Algotsson, Angelica Wackenfors, Richard Ingemansson
    Abstract:

    Background:Numerous authors have reported promising results with the use of Vacuum-Assisted Closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with resp

  • the impact of Vacuum Assisted Closure on long term survival after post sternotomy mediastinitis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Johan Nilsson, Richard Ingemansson
    Abstract:

    Background Post-sternotomy mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after Vacuum-Assisted Closure treated mediastinitis following coronary artery bypass grafting with that of patients without mediastinitis. Another objective was to identify risk factors for developing mediastinitis. Methods Forty-six patients were treated for mediastinitis, with Vacuum-Assisted Closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for mediastinitis. Results There was no difference in early or late survival between the mediastinitis group treated with Vacuum-Assisted Closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the Vacuum-Assisted Closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing mediastinitis. Conclusions This study suggests that patients with Vacuum-Assisted Closure treated mediastinitis may have similar long-term survival as patients without mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that Vacuum-Assisted Closure therapy minimizes the negative effects of mediastinitis on late survival after coronary artery bypass grafting.

Lars Algotsson - One of the best experts on this subject based on the ideXlab platform.

  • Vacuum Assisted Closure of the sternotomy wound respiratory mechanics and ventilation
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Ronny Gustafsson, Johan Sjogren, Malin Malmsjo, Lars Algotsson, Angelica Wackenfors, Richard Ingemansson
    Abstract:

    Background:Numerous authors have reported promising results with the use of Vacuum-Assisted Closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with resp

  • blood flow responses in the peristernal thoracic wall during Vacuum Assisted Closure therapy
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Angelica Wackenfors, Johan Sjogren, Ronny Gustafsson, Richard Ingemansson, Lars Algotsson, Malin Malmsjo
    Abstract:

    Background Vacuum-Assisted Closure (VAC) therapy is a recently introduced method for the treatment of poststernotomy mediastinitis. The aim of this study was to examine the effects of negative pressure on peristernal soft tissue blood flow and metabolism because the mechanisms by which Vacuum-Assisted Closure therapy promotes wound healing are not known in detail. Methods Microvascular blood flow was examined by laser Doppler velocimetry in an uninfected porcine sternotomy wound model. Microvascular blood flow was examined in the muscular and subcutaneous tissue, at different distances from the wound edge, after the application of −50 to −200 mm Hg. Wound fluid pH, partial pressures of oxygen and carbon dioxide, bicarbonate, and lactate were analyzed after 0, 30, and 60 minutes of continuous negative pressure. Results Vacuum-Assisted Closure therapy induced an increase in the microvascular blood flow a few centimeters from the wound edge. In muscular tissue, the distance from the wound edge to the position at which the blood flow was increased was shorter than that in subcutaneous tissue. Close to the wound edge, relative hypoperfusion was observed. The hypoperfused zone was larger at high negative pressures and was especially prominent in subcutaneous tissue. Wound fluid partial pressure of oxygen and lactate levels were increased after 60 minutes of Vacuum-Assisted Closure therapy, which may be the result of changes in the microvascular blood flow. Conclusions Vacuum-Assisted Closure therapy induces a change in microvascular blood flow that is dependent on the pressure applied, the distance from the wound edge, and the tissue type. It may be beneficial to tailor the negative pressure used for Vacuum-Assisted Closure therapy according to the wound tissue composition. Wound fluid partial pressure of oxygen and lactate levels increased during Vacuum-Assisted Closure therapy. This combination is known to promote wound healing.

  • effects of Vacuum Assisted Closure therapy on inguinal wound edge microvascular blood flow
    Wound Repair and Regeneration, 2004
    Co-Authors: Angelica Wackenfors, Johan Sjogren, Ronny Gustafsson, Richard Ingemansson, Lars Algotsson, Malin Malmsjo
    Abstract:

    Vacuum-Assisted Closure (VAC) therapy has been shown to facilitate wound healing. Data on the mechanisms are scarce, although beneficial effects on blood flow and granulation tissue formation have been presented. In the current study, laser Doppler was used to measure microvascular blood flow to an inguinal wound in pigs during VAC therapy (-50 to -200 mmHg), including consideration of the different tissue types and the distance from the wound edge. VAC treatment induced an increase in microvascular blood flow a few centimeters from the wound edge. The increase in blood flow occurred closer to the wound edge in muscular as compared to subcutaneous tissue (1.5 cm and 3 cm, at -75 mmHg). In the immediate proximity to the wound edge, blood flow was decreased. This hypoperfused zone was increased with decreasing pressure and was especially prominent in subcutaneous as compared to muscular tissue (0-1.9 cm vs. 0-1.0 cm, at -100 mmHg). When VAC therapy was terminated, blood flow increased multifold, which may be due to reactive hyperemia. In conclusion, VAC therapy affects microvascular blood flow to the wound edge and may thereby promote wound healing. A low negative pressure during treatment may be beneficial, especially in soft tissue, to minimize possible ischemic effects. Intermittent VAC therapy may further increase blood flow.

  • Vacuum Assisted Closure therapy guided by c reactive protein level in patients with deep sternal wound infection
    The Journal of Thoracic and Cardiovascular Surgery, 2002
    Co-Authors: Ronny Gustafsson, Per Johnsson, Lars Algotsson, Sten Blomquist, Richard Ingemansson
    Abstract:

    BACKGROUND: Deep sternal wound infection is a serious and potentially lethal complication of cardiac surgery when performed through a median sternotomy. We describe the outcome of a new treatment strategy with C-reactive protein level-guided Vacuum-Assisted Closure used at our department. METHODS: Data from 16 consecutive adult patients who had deep sternal wound infections after cardiac surgery were reviewed. Patients with superficial infection or sterile dehiscence were not included. All patients with postoperative deep sternal wound infections were treated with first-line Vacuum-Assisted Closure therapy, followed by direct surgical Closure. A purpose-built Vacuum-Assisted Closure system consisting of polyurethane foam pieces and a special pump unit was used. The foam was placed in the wound after debridement of foreign material and necrotic tissue. The wound was covered with adhesive drape and connected to the pump unit, which was programmed to create a continuous negative pressure of 125 mm Hg in the wound cavity. Intravenous antibiotics were given according to tissue-culture results. The patients were immediately extubated after the operation. When ingrowth of granulation tissue was observed in all parts of the wound and the plasma C-reactive protein level showed a steady decline to 30 to 70 mg/L or less without confounding factors, such as tissue injuries or concomitant infections, the sternotomy was rewired, and the wound was closed. RESULTS: All patients were alive and free from deep sternal wound infection 3 months after the operation. The median Vacuum-Assisted Closure treatment time until surgical Closure was 9 days (range, 3-34 days), and the median C-reactive protein level at Closure was 45 mg/L (range, 20-173 mg/L). The median hospital stay was 22 days (range, 12-120 days). CONCLUSIONS: Early Vacuum-Assisted Closure treatment, followed by surgical Closure guided by the plasma C-reactive protein level, is a reliable and easily applied new strategy in patients with postoperative deep sternal wound infection.

  • Vacuum Assisted Closure therapy guided by c reactive protein level in patients with deep sternal wound infection
    The Journal of Thoracic and Cardiovascular Surgery, 2002
    Co-Authors: Ronny Gustafsson, Per Johnsson, Lars Algotsson, Sten Blomquist, Richard Ingemansson
    Abstract:

    BACKGROUND: Deep sternal wound infection is a serious and potentially lethal complication of cardiac surgery when performed through a median sternotomy. We describe the outcome of a new treatment strategy with C-reactive protein level-guided Vacuum-Assisted Closure used at our department. METHODS: Data from 16 consecutive adult patients who had deep sternal wound infections after cardiac surgery were reviewed. Patients with superficial infection or sterile dehiscence were not included. All patients with postoperative deep sternal wound infections were treated with first-line Vacuum-Assisted Closure therapy, followed by direct surgical Closure. A purpose-built Vacuum-Assisted Closure system consisting of polyurethane foam pieces and a special pump unit was used. The foam was placed in the wound after debridement of foreign material and necrotic tissue. The wound was covered with adhesive drape and connected to the pump unit, which was programmed to create a continuous negative pressure of 125 mm Hg in the wound cavity. Intravenous antibiotics were given according to tissue-culture results. The patients were immediately extubated after the operation. When ingrowth of granulation tissue was observed in all parts of the wound and the plasma C-reactive protein level showed a steady decline to 30 to 70 mg/L or less without confounding factors, such as tissue injuries or concomitant infections, the sternotomy was rewired, and the wound was closed. RESULTS: All patients were alive and free from deep sternal wound infection 3 months after the operation. The median Vacuum-Assisted Closure treatment time until surgical Closure was 9 days (range, 3-34 days), and the median C-reactive protein level at Closure was 45 mg/L (range, 20-173 mg/L). The median hospital stay was 22 days (range, 12-120 days). CONCLUSIONS: Early Vacuum-Assisted Closure treatment, followed by surgical Closure guided by the plasma C-reactive protein level, is a reliable and easily applied new strategy in patients with postoperative deep sternal wound infection. (Less)