Purpose:To assess vancomycin paste effect on poststernotomy healing in high-risk coronary artery bypass grafting (CABG) patients compared to bone wax using the 6-point computed tomography (CT) score. Additionally assessed the reliability of this score and its relationship to the occurrence of infection. Patients and Methods: A prospective comparative analysis included 126 high-risk CABG patients. The patients were randomly assigned into bone wax or vancomycin paste for sternal haemostasis. All patients were submitted to CT examinations 6-months postoperative. Two radiologists independently reviewed all CT scans to assess sternal healing using the 6-point CT score. The CT healing score of the two groups was compared. The kappa statistics were used to calculate the inter-reader agreement (IRA) of the 6-point CT score. Results: The final analysis included 61 patients in each group. The main CT score for sternal healing was 3.9±0.4 in the vancomycin group and 3.3±0.8 in the bone wax group. Patients in the vancomycin group had a higher statistically significant improvement in CT healing score than those in the bone wax group (p<0.001). There was no statistically significant relationship (p = 0.79) between the occurrence of infection and the 6-point CT score in the vancomycin group. The overall IRA of the 6-point CT score was good in two groups (κ = 0.79 in the vancomycin group and = 0.78 in the bone wax group). Conclusion: Vancomycin paste had a better CT healing score and can be used as a sternal haemostatic material instead of bone wax. The 6-point CT healing score is a reliable diagnostic tool for evaluating sternal healing.

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.

Background: Drainless minimally invasive video-assisted thoracoscopic surgery (VATS) has improved perioperative outcomes and has become the standard of care for many thoracic procedures. Objectives: This study aimed to assess safety and perioperative outcomes of omitting chest tube drainage after VATS among eligible selected patients Methods: This study included 48 patients eligible for VATS and fulfilling the inclusion and exclusion criteria of omitting chest tube drain where, they were randomly allocated into two groups: Group-I (Drainless group) included 24 patients undergoing VATS with intra operative omitting of chest tube drains after an air leakage test and group-II (Drainage group) that included 24 patients undergoing VATS with conventional treatment using standard chest tube drainage. Results: Omitting chest tube drainage improved the median of operation time (116.0 minutes), average post-operative pain score per day (1.66) and shortened median of postoperative duration of hospital stay (1.0 days) among patients in drainless group-I compared to 139 minutes, 4.8 and 3.5 days among patient in drainage group-II (P<0.001) respectively. Uniportal VATS procedure, VATS sympathectomy, male sex, younger age and non-smoking habits in eligible selected patients with omitting chest tube drainage among them expressed significantly the lowest postoperative pain score, shortest postoperative duration of hospital stay and the least operation time with minimal risk of perioperative complications compared to drainage group-II (P<0.01). Conclusions: Omitting chest tube drainage after VATS is feasible in eligible selected patients and improved its efficacy, safety and perioperative outcomes (postoperative pain, hospital stay length, and the risk of perioperative complications).