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Traylor LB, Bhatia G, Blackhurst D, Wallenborn G, Ewing A, Bolton W, Davis B. Efficacy of incisional negative pressure therapy in preventing post-sternotomy wound complications. Am J Surg 2023; 226:762-767. [PMID: 37453803 DOI: 10.1016/j.amjsurg.2023.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sternal wound infections represent a source of significant morbidity and mortality following median sternotomy. The use of incisional negative pressure wound therapy in prevention has yet to be elucidated. METHODS A retrospective study was conducted before and after a universal wound care protocol was implemented including the prophylactic use of negative pressure wound therapy (NPWT). The primary endpoint was sternal infections within 90 days of the index operation. RESULTS In the control period, there was a 3.0% rate of sternal infection within 90 days compared to 0.8% in the intervention period (p < 0.001). An odds ratio of 0.25 (95% confidence interval 0.11, 0.57; p < 0.001) in the intervention period as compared to the control period was demonstrated. CONCLUSIONS The use of a standardized wound care protocol including the universal application of NPWT for patients undergoing cardiac surgery with median sternotomy was an independent predictor of decreased rates of sternal infection.
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Affiliation(s)
- L B Traylor
- University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - G Bhatia
- Prisma Health - Upstate, Greenville, SC, 29605, USA.
| | - D Blackhurst
- Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - G Wallenborn
- Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - A Ewing
- Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - W Bolton
- Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - B Davis
- Prisma Health - Upstate, Greenville, SC, 29605, USA
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Song Y, Chu W, Zhang M, Liu Z, Li D, Zhao F, Zhang B, Gao M, Yuan H, Shen C. A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet-rich plasma and negative pressure trauma therapy. Int Wound J 2023; 20:3457-3466. [PMID: 37269235 PMCID: PMC10588312 DOI: 10.1111/iwj.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/05/2023] Open
Abstract
Deep sternal wound infection (DSWI) is a relatively complex wound in wound reconstruction surgery. Because plastic surgeons deal with DSWI patients late. The primary healing (healing by first intention) after reconstruction of DSWI is restricted by many preoperative risk factors. The purpose of this study is to explore and analyse the risk factors of primary healing failure in patients with DSWI treated with platelet-rich plasma (PRP) and negative pressure trauma therapy (NPWT). 115 DSWI patients treated with the PRP and NPWT (PRP + NPWT) modality were retrospectively (2013-2021) analysed. They were divided into two groups according to primary healing results after the first PRP + NPWT treatment. Univariate and multivariate analyses were used to compare the data of the two groups to find out the risk factors and their optimal cut-off values were identified by ROC analysis. The primary healing results, debridement history, wound size, sinus, osteomyelitis, renal function, bacterial culture, albumin (ALB), platelet (PLT) between the two groups were significantly different (P < 0.05). Binary logistic regression showed that osteomyelitis, sinus, ALB and PLT were the risk factors affecting primary healing outcomes (P < 0.05). ROC analysis showed that AUC for ALB in the non-primary healing group was 0.743 (95% CI: 0.650-0.836, P < 0.05) and its optimal cutoff value of 31 g/L was associated with primary healing failure with a sensitivity of 96.9% and specificity of 45.1%. AUC for PLT in the non-primary healing group was 0.670 (95% CI: 0.571 ~ 0.770, P < 0.05) its optimal cutoff value of 293 × 109 /L was associated with primary healing failure with a sensitivity of 72.5% and specificity of 56.3%. In the cases included in this study, the success rate of primary healing of DSWI treated with PRP + NPWT was not affected by the most common preoperative risk factors for wound non-union. It is indirectly confirmed that PRP + NPWT is an ideal treatment. However, it should be noted that it will still be adversely affected by sinus osteomyelitis, ALB and PLT. The patients need to be carefully evaluated and corrected before reconstruction.
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Affiliation(s)
- Yaoyao Song
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Wanli Chu
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Ming Zhang
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Zhaoxing Liu
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Dawei Li
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Fan Zhao
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Bohan Zhang
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Mengmeng Gao
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Huageng Yuan
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Chuanan Shen
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
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3
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Song Y, Chu W, Sun J, Liu X, Zhu H, Yu H, Shen C. Review on risk factors, classification, and treatment of sternal wound infection. J Cardiothorac Surg 2023; 18:184. [PMID: 37208736 DOI: 10.1186/s13019-023-02228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/02/2023] [Indexed: 05/21/2023] Open
Abstract
Sternal wound infection (SWI) is the most common complication of the median sternal incision. The treatment time is long, and the reconstruction is difficult, which causes challenges for surgeons. Plastic surgeons were often involved too late in such clinical scenarios when previous empirical treatments failed and the wound damage was relatively serious. Accurate diagnosis and risk factors against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post-cardiac surgery is important for specific categorization and management. Not familiar with this kind of special and complex wound, objectively increasing the difficulty of wound reconstruction. The purpose of this comprehensive review is to review the literature, introduce various SWI risk factors related to wound nonunion, various classification characteristics, advantages and disadvantages of various wound reconstruction strategies, to help clinicians understand the pathophysiological characteristics of the disease and choose a better treatment method.
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Affiliation(s)
- Yaoyao Song
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Wanli Chu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Jiachen Sun
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xinzhu Liu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Hongjuan Zhu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Hongli Yu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Chuan'an Shen
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China.
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4
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Steele D, Walker A. 'Vancowax' for haemostasis and topical antibiotic post sternotomy. Ann R Coll Surg Engl 2023; 105:385. [PMID: 36239947 PMCID: PMC10066641 DOI: 10.1308/rcsann.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- D Steele
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | - A Walker
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
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Walkden A, Cantin P, Malik T. Ultrasound-guided wire localisation to aid excision of cervical nodes. Ann R Coll Surg Engl 2023; 105:384. [PMID: 35446713 PMCID: PMC10066651 DOI: 10.1308/rcsann.2021.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Walkden
- Royal Cornwall Hospitals NHS Trust, UK
| | - P Cantin
- University Hospitals Plymouth NHS Trust, UK
| | - T Malik
- University Hospitals Plymouth NHS Trust, UK
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Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. J Clin Med 2022; 11:jcm11236991. [PMID: 36498567 PMCID: PMC9738257 DOI: 10.3390/jcm11236991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy.
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Affiliation(s)
- Agnieszka Zukowska
- Department of Infection Control, Regional Hospital Stargard, 73-110 Stargard, Poland
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Care and Acute Intoxication, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence: ; Tel.: +48-504-451-924
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