Clinical Outcome of Patients With Deep Sternal Wound Infection Managed by Vacuum-Assisted Closure Compared to Conventional Therapy With Open Packing: A Retrospective Analysis

Fuchs, U; Zittermann, Armin; Stuettgen, Benjamin; Groening, Arndt; Minami, Kazutomo; Köerfer, Reiner

doi:10.1016/j.athoracsur.2004.08.032

Cited by 127 publications

(109 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In case of diagnosis of DSWI, an early application of NPWT was associated to a faster healing and an increased likelihood of survival [18,97,101,102] . Moreover, several studies demonstrated shorter treatment duration and length of hospital stay, as well as lower costs in patients treated with NPWT [96,98,100,103] . NPWT was also successfully applied in the case of MRSA mediastinitis and as a temporizing treatment prior to secondary closure in mediastinitis due to Candida [90,104,105] .…”

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

“…This wound-healing technique is based on the application of continuous or intermittent negative pressure to a wound, which results in arteriolar dilatation and, subsequently, determines wound perfusion and granulation tissue proliferation [57,85,93] . In vitro and clinical studies designed to determine the effect of NPWT lent convincing evidence of efficacy and safety in term of decrease of edema, exudation, and microbial colonization as well as reduction of inflammatory cytokine release [57,85,[98][99][100] . In case of diagnosis of DSWI, an early application of NPWT was associated to a faster healing and an increased likelihood of survival [18,97,101,102] .…”

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

View full text Add to dashboard Cite

Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

show abstract

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

View full text Add to dashboard Cite

show abstract

“…Since the report of Obdeijn et al 15) in 1999, however, VAC therapy has been spreading rapidly. 16) It is applied to refractory mediastinitis as a less invasive treatment. VAC therapy applies stronger negative pressure than usual aspiration drainage but is highly safe.…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aortic Abscess around the Elephant Trunk

Fujii

Kawasaki

Katayanagi

et al. 2015

ATCS

View full text Add to dashboard Cite

A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

show abstract

“…This enables mobilization of the patients and allows them either to breathe spontaneously or to be weaned from artifi cial ventilation during the inherent therapy 8,11 . Further, the stabilisation of the remaining sternal edges may be helpful in preventing right ventricular or conduit injury [8][9][10] . VAC therapy was primarily used as a bridge to allow cleaning and preparation of the wound bed for further reconstruction 8,10,11 .…”

Section: Discussionmentioning

confidence: 99%

“…The vacuum-assisted closure (VAC) system was introduced into clinical practice for the treatment of pressure ulcers and chronic debilitating wounds in 1997 7 . Recent studies have reported the eff ectiveness of the VAC system in the treatment of sternal wound infection in cardiac surgery, with emphasis on the treatment of deep sternal wound infection [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Vacuum-Assisted Closure in the Treatment of Sternal Wound Infection After Cardiac Surgery

Šimek¹,

Němec²,

Zálešák³

et al. 2007

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Aim: Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies.Methods: From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superfi cial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m 2 (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %).Results: Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to defi nite wound closure. Three patients (9 %) with chronic fi stula were re-admitted 1 to 6 months after VAC therapy.Conclusions: VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an eff ective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.

show abstract

Clinical Outcome of Patients With Deep Sternal Wound Infection Managed by Vacuum-Assisted Closure Compared to Conventional Therapy With Open Packing: A Retrospective Analysis

Cited by 127 publications

References 17 publications

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Deep sternal wound infection after cardiac surgery: Evidences and controversies

A Case of an Aortic Abscess around the Elephant Trunk

Vacuum-Assisted Closure in the Treatment of Sternal Wound Infection After Cardiac Surgery

Contact Info

Product

Resources

About