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Gauntt J, Cox VK, Duffy V, Deitemyer M, Lloyd E, Bigelow A, McConnell P, Simsic J. Negative pressure therapy for ECMO cannula stabilization. Perfusion 2024:2676591241236640. [PMID: 38400702 DOI: 10.1177/02676591241236640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Cannula stabilization for extracorporeal membrane oxygenation (ECMO) is important for patient mobilization and rehabilitation. Limitations to mobilization on ECMO include staff discomfort and cannula instability. We utilized the technique of negative pressure therapy for ECMO cannula stabilization to improve mobilization. Negative pressure therapy for ECMO cannula stabilization can be utilized safely for a variety of cannulation sites in any patient age from newborns to adults. This wound management strategy may facilitate patient mobilization and rehabilitation therapies in addition to extending cannula site duration.
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Affiliation(s)
- Jennifer Gauntt
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Vicky Duffy
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Matt Deitemyer
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Eric Lloyd
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amee Bigelow
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Patrick McConnell
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Janet Simsic
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
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Fadaly AS, Abdellatif GM, Saeed SE, Brik A, Elsharawy M, Deebis A, Elfwakhry RM, Shemais DS. Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized Controlled Trial. Int J Gen Med 2022; 15:7929-7939. [PMID: 36317099 PMCID: PMC9617555 DOI: 10.2147/ijgm.s388446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group. Materials and Methods A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival. Results The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55±3.57 and it was 32.61±8.39 showing high statistically significant difference (p<0.001). Patients in the primary closure group had earlier discharge from hospital 15.77±4.18 than vacuum assisted group 42.61±8.39, with high statistically significant difference (p<0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up. Conclusion Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.
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Affiliation(s)
- Ahmed S Fadaly
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Sameh E Saeed
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Brik
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mamdouh Elsharawy
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Deebis
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Dina Said Shemais
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt,Correspondence: Dina Said Shemais, Department of cardiothoracic surgery, Zagazig University, Zagazig, 44631, Egypt, Tel +201090726390, Email
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Vacuum-Assisted Closure for the Treatment of Deep Sternal Wound Infection After Pediatric Cardiac Surgery. Pediatr Crit Care Med 2020; 21:150-155. [PMID: 31568260 DOI: 10.1097/pcc.0000000000002131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vacuum-assisted closure is being increasingly used to treat deep sternal wound infection following cardiac surgery, but most of the data refer to adults. This study investigated the safety and efficacy of vacuum-assisted closure in pediatric patients. DESIGN Retrospective file review. SETTING Tertiary pediatric medical center. PATIENTS All children with deep sternal wound infection treated with vacuum-assisted closure in 2003-2016. INTERVENTIONS Epidemiological, clinical, and microbiological data were collected from the medical records. MEASUREMENTS AND MAIN RESULTS The cohort included 50 patients (0.9% of cardiac patients operated during the study period) of median age 6.5 months (interquartile range, 2-12.75 mo; range, 1 wk to 14 yr) and median weight 5.1 kg (interquartile range, 4-9.75 kg). The most frequent heart defects were tetralogy of Fallot (22%) and ventricular septal defect (20%); 38% of patients had cyanotic heart disease. Deep sternal wound infections appeared a median of 10 days postoperatively (interquartile range, 7-14 d; range 3-100 d). Vacuum-assisted closure was applied a median of 13 days postoperatively (interquartile range, 10-18.5 d; range, 5-103 d) for a median duration of 10 days (interquartile range, 7-13.25 d; range, 1-21 d). Wound cultures were positive in 48 patients (96%); most isolates were Gram-positive (76%). The main bacterial pathogen was methicillin-susceptible Staphylococcus aureus (61%). Most patients were treated with cloxacillin for a median of 38 days (interquartile range, 28-42 d; range, 9-189 d). There were no statistically significant differences in clinical or treatment characteristics between bacteremic (56%) and nonbacteremic patients. Compared with older patients, infants less than 3 months old (36%) had a significantly longer hospitalization time (41 vs 25 d; p = 0.001) and higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality Category (3 vs 2; p = 0.003). All cases except one (contact dermatitis) were uneventful. In 10 patients, wounds were closed surgically after vacuum-assisted closure. Two patients required a pectoralis flap, both treated before 2005. One of the two deaths was infection-related. CONCLUSIONS Vacuum-assisted closure is a feasible treatment option of deep sternal wound infection after pediatric cardiac surgery and was not associated with independent morbidity.
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Percutaneous Continuous Irrigation and Drainage for Infected Obturator Bypass Graft. Ann Vasc Surg 2019; 61:467.e1-467.e6. [PMID: 31376540 DOI: 10.1016/j.avsg.2019.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/21/2019] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
The treatment for obturator bypass graft infection has been rarely reported and is a surgical challenge because it is difficult to debride infected tissue around the graft located in the deep route and to ensure an alternative revascularization route in patients with a history of inguinal infection. Percutaneous continuous irrigation and drainage is an effective and less invasive definitive therapy for obturator bypass graft infection.
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Ivanzov S, Soynov I, Kulyabin Y, Zubritskiy A, Voitov A, Omelchenko A, Arkhipov A, Bogachev-Prokophiev A. Vacuum-assisted closure versus closed irrigation for deep sternal wound infection treatment in infants: a propensity score-matched study. Interact Cardiovasc Thorac Surg 2019; 29:776-782. [DOI: 10.1093/icvts/ivz167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/10/2019] [Accepted: 06/15/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
This study aimed to compare vacuum-assisted closure therapy (VAC) and closed irrigation drainage therapy (CID) for deep sternal wound infection treatment in infants.
METHODS
From January 2008 to March 2018, 69 patients (1.73%) had deep sternal wound infection. They were divided into 2 groups: patients treated with VAC therapy (VAC group, 29 patients) and those treated with CID therapy (CID group, 40 patients). After performing a propensity score analysis (1:1) for the entire sample, 16 patients receiving VAC therapy were matched with 16 patients receiving CID therapy.
RESULTS
No significant difference was noted between both groups regarding age [d = 0.045; 95% confidence interval (CI) 0.99–1.07], gender (d = 0.001; 95% CI 0.22–4.45), weight (d = 0.011; 95% CI 0.73–1.35), body surface area (d = −0.023; 95% CI 0.01–5733.08), cardiopulmonary bypass (d = 0; 95% CI 0.16–5.90) and open chest duration (d = −0.112; 95% CI 0.31–5.16). Five patients died in the CID group (31.25%) during hospital stay, and there were no deaths in the VAC group (P = 0.024). Recurrence of mediastinitis occurred in 1 patient (6.25%) from the VAC group and in 6 patients (37.5%) from the CID group (P = 0.037). The multivariable regression analysis revealed that the CID method was the only risk factor for remediastinitis (odds ratio 17.3; 95% CI 1.04–286.75; P = 0.046).
CONCLUSIONS
Use of VAC therapy in infants with deep sternal wound infection was associated with a substantial decrease in the mortality rate and duration of therapy compared with CID technique. The CID technique was an independent risk factor for recurrence of mediastinitis.
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Affiliation(s)
- Sergey Ivanzov
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Ilya Soynov
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Kulyabin
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey Zubritskiy
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey Voitov
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander Omelchenko
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey Arkhipov
- Department of Congenital Heart Disease, National Medical Research Center, Novosibirsk, Russian Federation
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Ikeno Y, Sakakibara S, Yokawa K, Kitani K, Nakai H, Yamanaka K, Inoue T, Tanaka H, Terashi H, Okita Y. Post-sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement†. Eur J Cardiothorac Surg 2019; 55:975-983. [PMID: 30544183 DOI: 10.1093/ejcts/ezy389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Yuki Ikeno
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keitaro Kitani
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Nakai
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Santosa KB, Keller M, Olsen M, Keane AM, Sears ED, Snyder-Warwick AK. Negative-Pressure Wound Therapy in Infants and Children: A Population-Based Study. J Surg Res 2019; 235:560-568. [PMID: 30691843 PMCID: PMC6364568 DOI: 10.1016/j.jss.2018.10.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the safety and benefits of negative-pressure wound therapy (NPWT) have been clearly demonstrated in the adult population, studies evaluating the safety and describing the use of NPWT in the pediatric population have been limited. Given this paucity, the goals of this study were to (1) evaluate the literature dedicated to NPWT use in infants and children and (2) leverage a population-level analysis to describe the experience of NPWT use in the pediatric population. MATERIALS AND METHODS We performed a literature review and analyzed the Truven Health Analytics MarketScan Commercial Claims Databases from 2006 to 2014 to identify infants and children treated with NPWT. We evaluated patient characteristics, indications, complications before and after NPWT placement, and health care utilization within 30 d of NPWT placement. RESULTS We identified 457 articles, 11 of which fit our inclusion criteria. Most studies (65.2%) were case reports or series with less than 10 patients. In addition, we identified 3184 patients aged younger than of 18 y who were treated with NPWT between 2006 and 2014. Serious incident complications within 30 d after NPWT placement were rare (bleeding 0.6%, septicemia 0.5%, and sepsis 0.5%). CONCLUSIONS Despite the lack of robust studies, NPWT is widely used for many indications and across different ages and providers. Given the low incidence of serious complications, we conclude that NPWT use in infants and children is safe and can be effectively used by different providers spanning surgical and nonsurgical disciplines.
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Affiliation(s)
- Katherine B. Santosa
- Postdoctoral Research Fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110;
| | - Matt Keller
- Senior Statistical Data Analyst, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Margaret Olsen
- Professor, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Alexandra M. Keane
- Medical Student, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Erika D. Sears
- Assistant Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive Ann Arbor, MI 48109
| | - Alison K. Snyder-Warwick
- Assistant Professor, Division of Plastic Surgery, Department of Surgery, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110 St. Louis, MO
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Rodrigues AC, Saad KR, Saad PF, Otsuki DA, dos Santos LC, Rasslan S, de Souza Montero EF, Utiyama EM. Continuous peritoneal lavage with vacuum peritoneostomy: an experimental study. Clinics (Sao Paulo) 2019; 74:e937. [PMID: 31291390 PMCID: PMC6607936 DOI: 10.6061/clinics/2019/e937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy. METHOD Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT. RESULTS Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces. CONCLUSION Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.
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Affiliation(s)
- Adilson Costa Rodrigues
- Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Karen Ruggeri Saad
- Faculdade de Medicina, Universidade Federal do Vale do São Francisco, Petrolina, PE, BR
| | - Paulo Fernandes Saad
- Faculdade de Medicina, Universidade Federal do Vale do São Francisco, Petrolina, PE, BR
| | - Denise Aya Otsuki
- Laboratorio de Anestesiologia (LIM-08), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luana Carla dos Santos
- Laboratorio de Fisiopatologia Cirurgica (LIM-62), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Samir Rasslan
- Laboratorio de Fisiopatologia Cirurgica (LIM-62), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edna Frasson de Souza Montero
- Laboratorio de Fisiopatologia Cirurgica (LIM-62), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Edivaldo M Utiyama
- Clinica Cirurgica III, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Vacuum-assisted closure combined with a closed suction irrigation system for treating postoperative wound infections following posterior spinal internal fixation. J Orthop Surg Res 2018; 13:321. [PMID: 30558614 PMCID: PMC6297981 DOI: 10.1186/s13018-018-1024-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection. METHODS We conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records. RESULTS Wound size decreased significantly after 1 week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8 days. The wound healed completely after an average of 17 days, and the average hospital stay was 33 days. There was no recurrence of infection at the 1-year follow-up. CONCLUSIONS This study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.
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Onan IS, Yildiz O, Tüzün B, Timur B, Haydin S. Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience. Artif Organs 2018; 43:119-124. [DOI: 10.1111/aor.13321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 03/13/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ismihan Selen Onan
- İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital Istanbul Turkey
| | - Okan Yildiz
- İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital Istanbul Turkey
| | - Behzat Tüzün
- İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital Istanbul Turkey
| | - Barış Timur
- İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital Istanbul Turkey
| | - Sertaç Haydin
- İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital Istanbul Turkey
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Takanashi M, Ogata S, Honda T, Nomoto K, Mineo E, Kitagawa A, Ando H, Kimura S, Nakahata Y, Oka N, Miyaji K, Ishii M. Timing of Haemophilus influenzae type b vaccination after cardiac surgery. Pediatr Int 2016; 58:691-7. [PMID: 26718621 DOI: 10.1111/ped.12899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/29/2015] [Accepted: 12/24/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The best time for vaccination in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery is unclear, but it is important to prevent Haemophilus influenzae type b (Hib) infection in infants with CHD after CPB surgery. To identify the best time for Hib vaccination in infants with CHD after CPB surgery, we investigated the immunological status, and the efficacy and safety of Hib vaccination after CPB surgery. METHODS Sixteen subjects who underwent surgical correction of ventricular septal defect with CPB were investigated. Immunological status and cytokines were analyzed before surgery, 2 months after surgery, and before Hib booster vaccination. Hib-specific IgG was also measured to evaluate the effectiveness of vaccination. RESULTS Immunological status before and 2 months after surgery (e.g. whole blood cells and lymphocyte subset profile) was within the normal range and no subjects had hypercytokinemia. Additionally, all subjects who received Hib vaccination at 2-3 months after CPB surgery had effective serum Hib-specific IgG level for protection against Hib infection without any side-effects. CONCLUSIONS CPB surgery does not influence acquired immunity and Hib vaccination may be immunologically safe to perform at 2 months after CPB surgery. Hib vaccination at 2-3 months after CPB surgery was effective in achieving immunization for infants with simple left-right shunt-type CHD.
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Affiliation(s)
- Manabu Takanashi
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shohei Ogata
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takashi Honda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Keiko Nomoto
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Eri Mineo
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hisashi Ando
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sumito Kimura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yayoi Nakahata
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Norihiko Oka
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
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Aver'ianova IV, Makarov SP, Stepanov AÉ, Razumovskiĭ AI, Vasil'ev KG. [Vacuum-therapy for complicated anterior abdominal wall wounds and intestinal fistulas in children]. Khirurgiia (Mosk) 2016:39-44. [PMID: 26977866 DOI: 10.17116/hirurgia2016239-44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To present results of VAC application in children with complicated wounds of anterior abdominal wall combined with intestinal and/or biliary fistulas. MATERIAL AND METHODS For the last 7 years 8 patients aged from 1.5 months to 15 years with infected postoperative wounds of anterior abdominal wall complicated by intestinal fistulas (6), biliary and intestinal fistulas (1) and biliary fistula (1) have been treated at the surgical department №2 of Russian Children's Clinical Hospital. All patients received complex medical therapy and local VAC-therapy. RESULTS Granulation and wound's size reduction were observed within first 7 days of VAC-therapy application in 5 (62.5%) children. In 4 (50%) patients at least 1 intestinal fistula has been closed in 15 days after VAC-therapy initiation on the average (range 7--24). Closure of all fistulas and wounds healing were observed in all patients in 28 days (range 16--42) after VAC-therapy initiation on the average. CONCLUSION VAC-therapy is safe and effective treatment of complicated wounds of anterior abdominal wall combined with intestinal and/or biliary fistulas in children.
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Affiliation(s)
- Iu V Aver'ianova
- Russian Children's Clinical Hospital of Health Ministry of the Russian Federation, Moscow
| | - S P Makarov
- Russian Children's Clinical Hospital of Health Ministry of the Russian Federation, Moscow
| | - A É Stepanov
- Russian Children's Clinical Hospital of Health Ministry of the Russian Federation, Moscow
| | - A Iu Razumovskiĭ
- Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University, Moscow
| | - K G Vasil'ev
- Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University, Moscow
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Enterococcus faecium Mediastinitis Complicated by Disseminated Candida parapsilosis Infection after Congenital Heart Surgery in a 4-Week-Old Baby. Case Rep Infect Dis 2015; 2015:543685. [PMID: 26605096 PMCID: PMC4641177 DOI: 10.1155/2015/543685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/29/2015] [Indexed: 12/02/2022] Open
Abstract
Background. Cardiac surgery offers multiple treatment options for children with congenital heart defects. However, infectious complications still remain a major cause of morbidity and mortality in these patients. Mediastinitis is a detrimental complication in children undergoing cardiac surgery. The risk of mediastinitis after delayed sternal closure is up to 10%. Case Presentation. We report a case of Enterococcus faecium mediastinitis in a 4-week-old female baby on extracorporeal membrane oxygenation after Norwood procedure. Although repeated antibiotic irrigation, debridement, and aggressive antibiotic treatment were started early, the pulmonary situation deteriorated. Candida parapsilosis was isolated from bronchoalveolar lavage after pulmonary hemorrhage. Disseminated C. parapsilosis infection with pulmonary involvement was treated with liposomal amphotericin B. Subsequently, inflammatory markers increased again and eventually C. parapsilosis was isolated from the central venous catheter. Conclusion. Children undergoing delayed sternal closure have a higher risk of mediastinitis. Therefore, antibiotic prophylaxis, for example, for soft tissue infection seems justified. However, long-term antibiotic treatment is a risk factor for fungal superinfection. Antifungal treatment of disseminated C. parapsilosis infection may fail in PICU patients with nonbiological material in place due to capacity of this species to form biofilms on medical devices. Immediate removal of central venous catheters and other nonbiological material is life-saving in these patients.
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Negative pressure wound therapy of chronically infected wounds using 1% acetic Acid irrigation. Arch Plast Surg 2015; 42:59-67. [PMID: 25606491 PMCID: PMC4297808 DOI: 10.5999/aps.2015.42.1.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/08/2022] Open
Abstract
Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.
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Takahara S, Sai S, Kagatani T, Konishi A. Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children. Interact Cardiovasc Thorac Surg 2014; 19:627-31. [DOI: 10.1093/icvts/ivu234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kawajiri H, Aeba R, Takaki H, Yozu R, Iwata S. Negative pressure therapy for post-sternotomy wound infections in young children. Interact Cardiovasc Thorac Surg 2014; 19:102-6. [PMID: 24648466 DOI: 10.1093/icvts/ivu050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Post-sternotomy wound infection remains a significant morbidity in congenital and paediatric cardiac surgery. However, the techniques used for this complication in children are not optimal in terms of mortality, morbidity and the use of medical resources. Negative pressure therapy is an effective modality in the treatment in adults, but reports of its use in children are limited. This study evaluated the use of negative pressure therapy in young children for post-sternotomy wound infections. METHODS From October 2004 to June 2012, 15 consecutive cases of post-sternotomy wound infections in patients ≤6 years of age were managed with negative pressure therapy, and these patients were followed up for ≥12 months after wound closure. The median Aristotle comprehensive complexity score was 9.9 ± 4.0. The infection was identified at a median of 16 days after surgery, and the procedure was performed within 24 h of diagnosis. No additional surgical procedures were applied. RESULTS No cases of hospital mortality or second surgery for infection control occurred. The median duration until wound closure was 25 days (range: 5-92 days). Further, no patient showed sternal instability at treatment termination. During the mean follow-up period of 45.8 ± 31.3 months after wound closure, no admission occurred for infection recurrence. According to a multivariable analysis, the infection depth and patient weight significantly lengthened treatment duration (P = 0.008 and 0.046, respectively). CONCLUSIONS Negative pressure therapy is an effective treatment modality for wound infections in paediatric cardiac surgery and results in low morbidity, mortality and medical resource use.
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Affiliation(s)
| | - Ryo Aeba
- Division of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Hidenobu Takaki
- Division of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Ryohei Yozu
- Division of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Satoshi Iwata
- Center for Infectious Diseases and Infection Control, Keio University, Tokyo, Japan
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Negative pressure wound therapy in infants and children: a single-institution experience. J Surg Res 2013; 184:658-64. [PMID: 23768766 DOI: 10.1016/j.jss.2013.05.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/22/2013] [Accepted: 05/10/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Information regarding the use of negative pressure wound therapy (NPWT) in the pediatric population is limited. Because of adverse outcomes in adult patients, the Food and Drug Administration issued a warning in 2011 about the use of NPWT in infants and children. METHODS We performed an institutional review board-approved, single-institution, retrospective review of pediatric patients who had undergone NPWT from 2007-2011. We collected the types of wounds for which NPWT was initiated, the NPWT outcomes, and the complications encountered. RESULTS The data from 290 consecutive patients were reviewed. Their average age was 9.3 y (range 12 d to 18 y), and their average weight was 46.5 kg (range 1.1-177). Of the wounds, 66% were classified as acute, 10% as chronic, and 24% as traumatic. The two most common indications were surgical wound dehiscence (n = 47) and skin grafting (n = 41). NPWT was used in 15 wounds containing surgical hardware, with 2 devices requiring eventual removal. NPWT was used for a median of 9 d per patient (two dressing changes). Complications occurred in 5 patients (1.7%). Documentation problems were noted in 44 patients. After NPWT, about one-third of the patients (n = 95 patients) were able to undergo delayed primary closure. CONCLUSIONS NPWT is an effective adjunct in wound healing and closure in the pediatric population, with no mortality ascribed to NPWT. Also, the complication rates were low.
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Durandy Y. Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment. World J Cardiol 2010; 2:391-8. [PMID: 21179306 PMCID: PMC3006475 DOI: 10.4330/wjc.v2.i11.391] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/07/2010] [Accepted: 10/14/2010] [Indexed: 02/06/2023] Open
Abstract
In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.
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Affiliation(s)
- Yves Durandy
- Yves Durandy, Perfusion and Intensive Care Unit in Pediatric Cardiac Surgery, Institut Hospitalier Jacques Cartier, Avenue du Noyer Lambert, 91300 Massy, France
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