Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydrodebridement with pulsed lavage and negative pressure wound therapies.

Automated Detection of Infection in Diabetic Foot Ulcer Images Using Convolutional Neural Network

A bacterial or bone infection in the feet causes diabetic foot infection (DFI), which results in reddish skin in the wound and surrounding area. DFI is the most prevalent and dangerous type of diabetic mellitus. It will mainly occur in people with heart disease, renal illness, or eye disease. The clinical signs and symptoms of local inflammation are used to diagnose diabetic foot infection. In assessing diabetic foot ulcers, the infection has significant clinical implications in predicting the likelihood of amputation. In this work, a diabetic foot infection network (DFINET) is proposed to assess infection and no infection from diabetic foot ulcer images. A DFINET consists of 22 layers with a unique parallel convolution layer with ReLU, a normalization layer, and a fully connected layer with a dropout connection. Experiments have shown that the DFINET, when combined with this technique and improved image augmentation, should yield promising results in infection recognition, with an accuracy of 91.98%, and a Matthews correlation coefficient of 0.84 on binary classification. Such enhancements to existing methods shows that the suggested approach can assist medical experts in automated detection of DFI.

Post-sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement†

OBJECTIVES

The aim of this study was to evaluate the early and long-term outcomes of our multidisciplinary strategy for treating deep sternal wound infection after aortic grafting, which consisted of debridement by a plastic surgeon, negative pressure wound therapy with continuous irrigation and chest wall reconstruction.

METHODS

We performed a retrospective analysis of 18 patients who had a deep sternal wound infection following aortic grafting through a median sternotomy between January 2009 and December 2017. All patients had organisms cultured from mediastinal tissue within 2 months from the initial aortic surgery. The prosthetic grafts were exposed in 15 patients during resternotomy. Our protocol involved repeat debridement and negative pressure wound therapy with continuous irrigation twice a week until the results of the culture were negative and chest wall reconstruction was complete.

RESULTS

The mean duration from primary aortic surgery to resternotomy was 23.7 ± 15.9 days. Except for 1 patient, 17 patients underwent chest wall reconstruction. The mean duration from resternotomy to chest wall reconstruction was 31.1 ± 28.0 days. The hospital mortality rate was 16.7% (3 patients), although no patients died of wound-related causes. The mean follow-up period was 2.9 ± 2.5 years. Overall survival was 69.6 ± 11.4% at 1 year and 54.2 ± 13.3% at 5 years. Freedom from reoperation for reinfection was 94.4 ± 5.4% at 5 years.

CONCLUSIONS

Our wound care strategy achieved acceptable early and late survival in patients who had deep sternal wound infection following aortic grafting. This strategy may benefit those who experience this devastating complication.