Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Deep Sternal Wound Infection and Mortality in Cardiac Surgery: A Meta-analysis

BACKGROUND

Deep sternal wound infection (DSWI) is a rare but severe complication after cardiac surgical procedures and has been associated with increased early morbidity and mortality. Studies reporting long-term outcomes in patients with DSWI have shown contradictory results. We performed a study-level meta-analysis evaluating the impact of DSWI on short- and long-term clinical outcomes.

METHODS

A systematic literature search was conducted to identify studies comparing short- and long-term outcomes of patients submitted to cardiac surgical procedures who developed DSWI and patients who did not. The primary outcome was overall mortality. Secondary outcomes were in-hospital mortality, follow-up mortality, major adverse cardiovascular events, myocardial infarction, and repeat revascularization. Postoperative outcomes were also investigated.

RESULTS

Twenty-four studies totaling 407 829 patients were included. Overall, 6437 (1.6%) patients developed DSWI. Mean follow-up was 3.5 years. DSWI was associated with higher overall mortality (incidence rate ratio [IRR], 1.99; 95% CI, 1.66-2.38; P < .001), in-hospital mortality (odds ratio, 3.30; 95% CI, 1.88-5.81; P < .001), follow-up mortality (IRR, 2.02; 95% CI, 1.39-2.94; P = .001), and major adverse cardiovascular events (IRR, 2.04; 95% CI, 1.60-2.59; P < .001). No differences in myocardial infarction and repeat revascularization were found, but limited studies reported those outcomes. DSWI was associated with longer postoperative hospitalization, stroke, myocardial infarction, and respiratory and renal failure. Sensitivity analyses on isolated coronary artery bypass grafting studies and by adjustment method were consistent with the main analysis.

CONCLUSIONS

Compared with patients who did not develop DSWI, patients with DSWI after cardiac surgical procedures had increased risk of death as well as short- and long-term adverse clinical outcomes.

Alginate/Gelatin Sponges Composited with ZnO Sponge Effective Extensibility and Compressibility as a Wound Dressing for the Care of Fracture Surgery

We designed and synthesized highly porous alginate and gelatin hydrogels with zinc oxide nanoparticles (AGZNPs) as dressings using sol–gel methods. The presence of functional groups and the surface characteristics of the as-synthesised dressings were analyzed via Fourier transforminfrared (FT-IR) spectroscopy, while their morphology was studied via scanning electron microscopy (SEM). Additionally, the mechanical, inflammatory, and antibacterial properties and biocompatibility of the AGZNPs were evaluated to determine the efficiency of these bandages for wound healing applications. The AGZNPs demonstrated enhanced inflammatory and antibacterial properties. The biocompatibility of the nanocomposites was investigated in noncancerous NIH3T3 human fibroblasts. Furthermore, in-vivo examinations showed that the composition of the synthesized AGZNPs enhanced wound healing and promoted rapid cell construction and growth. Therefore, the AGZNP strategy promotes the future application of these nanoformulation hydrogels for wound bandaging in fracture surgeries.