Postoperative mediastinitis and sternal osteomyelitis are serious complications that are difficult to manage, and they may be fatal. In our facility, the V.A.C.ATS^TM treatment system has been actively used to manage these complications since it became insurance-covered. Although it is possible to sufficiently perform wound bed preparation through favorable management, such as granulation and infection control, would healing cannot be achieved in a large number of cases due to the necessity of calculating medical fees within limited time frames. Therefore, in deep wound infections, it is necessary to finally perform reconstructive surgery using muscle (skin) or omental flaps to fill the dead space for wound closure. This paper reports such a case managed in our facility, and reviews the therapeutic strategies.

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Severe burns sometimes turn out to be fatal. Even though there are no accurate data regarding burn treatment in Japan, it may be estimated from statistics by diagnostic procedure combination (DPC) and the Tokyo Burn Emergency Liaison Council that among tens of thousands of patients receiving treatment at medical institutions annually, more than 6,000 of them are hospitalized for burn treatment, and hundreds of patients have died due to extensive burns during hospitalization. As it is important for clinicians to recognize the prognosis of patients at the time of hospitalization, various reports have reviewed burn mortality.
Of 135 cases which received inpatient treatment at our hospital during the six years from 2008, seven patients died during hospitalization. At our hospital, which has provided treatment led by plastic surgeons based on cooperation with each department without assigning any doctor exclusively to the intensive-care unit (ICU), we retrospectively reviewed factors predicting life prognosis at the time of hospitalization in severe cases and compared them with previous reports.
According to the results, total burn surface area, burn index, burn prognostic index, leukocyte count, serum albumin, lactic dehydrogenase, and total cholesterol are useful as predictors of mortality during hospitalization; these results are consistent with those of burn-dedicated facilities.

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