Results of intra-wound continuous negative pressure irrigation treatment for mediastinitis

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Keigo Morinagaa, Kensuke Kiyokawa*a, Hideaki Rikimarua, Shigeaki Aoyagib, Keiichiro Tayamab & Hidetoshi Akashiba Department of Plastic and Reconstructive Surgery and Maxillofacial Surgeryb Department of Surgery, Kurume University School of Medicine, Fukuoka, JapanCorrespondence: Keigo Morinaga, MD, Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka 830-0011, Japan. +81 942 31 7569. +81 942 0834. prsmf@med.kurume-u.ac.jp AbstractIntra-wound continuous negative pressure irrigation treatment (IW-CONPIT) was administered to cases of mediastinitis as the therapy of choice, with satisfactory results being obtained in terms of improved survival rates and quick healing of wounds. Accordingly, these treatment results and efficacy were evaluated. After debridement, a sponge was trimmed to conform to the shape of the wound and then it was attached to the surface of the wound. Two tubes with several side holes were placed within the sponge. In cases in which the blood vessels and/or the heart are exposed, an artificial dermis was attached to cover the blood vessels and/or the heart in order to not come in direct contact with the sponge. Next, the top of the wound was covered with polyethylene film to create an air-tight wound seal. A bottle of saline solution was connected to one of the tubes and a continuous aspirator to the other, and continuous negative pressure irrigation of the wound was thus carried out. After performing this treatment for 2–3 weeks, and when wound granulation improved, either skin grafts or the transplantation of muscle flaps was performed as necessary to achieve wound healing. A combination of the continuous negative pressure method and the continuous irrigation method resulted in improved healing rates and lower mortality rates for mediastinitis. It also significantly reduced the number of dressings, as well as the degree of labour and medical materials required; therefore, a reduced hospital stay and shorter treatment period was thus achieved using this treatment method.