VAC- vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection
When you have open heart surgery, the surgeon makes a cut (incision) that runs down the middle of your chest bone (sternum). The incision hopefully heals itself. But sometimes, people have complications that require treatment.
Two wound complications that can happen within 30 days of open heart surgery are:
The health care team will do exploration and closure procedures to treat the sternal wound. They usually take care of this in the operating room. They will:
After the wound is cleaned out, your surgeon may not close the wound. Your surgeon may pack the wound with a dressing, which will be changed often.
Or your surgeon may use a VAC dressing (vacuum-assisted closure), which is a negative pressure dressing. It increases blood flow around the sternum and improves healing.
Your surgeon may put a chest harness on you to make the chest bones more stable.
It may take days, weeks, or even months for the wound to be clean, clear of infection, and finally heal.
Once this occurs, the surgeon may use a muscle flap from your buttocks, shoulder, or upper chest to cover and close the wound.
You may have already been receiving wound care or treatment and antibiotics.
There are two main reasons for doing exploration and closure procedures for the chest wound after heart surgery:
If your health care team thinks you may have an infection in your chest incision, they may:
You will likely spend at least a few days in the hospital. After that, you will either:
At either place, you will receive antibiotics for 4 to 6 weeks in your veins (IV).
These complications can cause problems such as:
Haycock C, Laser C, Keuth J, Montefour K, Wilson M, Austin K, Coulen C, Boyle D. Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery. Journal of Cardiovascular Nursing. October 2005;20(5):299-305. PMID: 16141774
Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Singh, K., Anderson, E. Harper, J.G. Overview and management of sternal wound infection. Semin Plast Surg. Feb 2011;25(1): 25-33. PMID: 22294940
Last reviewed on: 9/26/2014
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.