Delayed aortic rupture resulting from postoperative superficial sternal wound infection

Kim, Su Wan; Lee, Seogjae; Chang, Jee Won

doi:10.21037/jtd.2016.05.09

Cited by 3 publications

(6 citation statements)

References 7 publications

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“…In our case, the major bleeding occurred from the aortotomy site. The aggressive DSWI probably exacerbated an aortitis, which led to thinning and perforation of the weakest point of the aortic wall as previously described by Kim et al 2 Sudden aortic rupture has a fatal outcome in most cases. 1,2 In our case a combination of "fortuitous" events allowed for a successful outcome.…”

Section: Discussionmentioning

confidence: 53%

“…Sudden aortic rupture is a catastrophic event that generally ends in patient death. 1,2 This case report illustrates not only the complications of a DSWI, but also the possibility to improvise major cardiac surgical procedure outside the operating theatre. To the best of our knowledge, this is the first report depicting the use of an endotracheal tube as haemostatic plug to control major bleeding from large vessels and one of the few reports of aortic rupture as consequence of DSWI.…”

Section: Discussionmentioning

confidence: 84%

“…1 Aortic rupture or dehiscence of an aortic suture can happen also as a consequence of post-cardiotomy deep sternal wound infections (DSWI), but reported outcomes of these cases are poor. 2 Diagnosis and treatment of such a complication can be challenging, especially if the sudden rupture happens outside the operating theatre where the establishment of an emergent surgical procedure is difficult. It is, thus, necessary to identify simple life-saving tools to control the aortic bleeding while bringing the patient to surgery.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Campanella¹,

Abbass²,

Marzi³

et al. 2022

F1000Res

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Background: Aortic rupture and suture dehiscence can complicate a cardiac operation, especially in case of infections of the surgical site. Such a complication can be life-threatening and require immediate surgical treatment. Case: We report the case of a 13-year-old girl who suffered a sudden dehiscence of the aortic suture line in the context of deep sternal wound infection, while in the surgical intensive care unit after a double valve replacement. Control of bleeding was obtained by the insertion of an endotracheal tube into the ascending aorta and inflation of the tube cuff to plug the aortic bleeding point. The extracorporeal circulation was then established and under deep hypothermic arrest the defect was successfully repaired. The patient was discharged 14 days after surgery and reviewed at the outpatient clinic in good health. Conclusions: An endotracheal tube can be used in cases of uncontrollable aortic bleeding as a life-saving tool to bridge the patient to adequate surgical treatment.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Campanella¹,

Abbass²,

Marzi³

et al. 2022

F1000Res

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“…However, the mortality rate can be as high as 25.7%-52.0% (1). At the same time, DSWI also leads to prolonged hospitalization, increased expected costs, re-entry into the ICU and even reoperation (1)(2)(3). Therefore, precautionary intervention before cardiac surgery and effective treatment after the occurrence of DSWI are significant (4).…”

Section: Introductionmentioning

confidence: 99%

Deep sternal wound infection and pectoralis major muscle flap reconstruction: A single-center 20-year retrospective study

et al. 2022

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BackgroundOne of the most drastic complications of median sternal incision is deep sternal wound infection (DSWI), as it can lead to prolonged hospitalization, increased expected costs, re-entry into the ICU and even reoperation. Since the pectoralis major muscle flap (PMMF) technique was proposed in the 1980s, it has been widely used for sternal reconstruction after debridement. Although numerous studies on DSWI have been conducted over the years, the literature on DSWI in Chinese population remains limited. The purpose of this study was to investigate the clinical characteristics of DSWI in patients and the clinical effect of the PMMF at our institution.MethodsThis study retrospectively analyzed all 14,250 consecutive patients who underwent cardiac surgery in the Department of Cardiothoracic Surgery of Drum Tower Hospital from 2001 to 2020. Ultimately, 134 patients were diagnosed with DSWI.,31 of whom had recently undergone radical debridement and transposition of the PMMF in the cardiothoracic surgery or burns and plastic surgery departments because of DSWIs, while the remaining patients had undergone conservative treatment or other methods of dressing debridement.ResultsIn total, 9,824 patients were enrolled in the study between 2001 and 2020, of whom 134 met the DSWI criteria and 9690 served as controls. Body mass index (OR = 1.08; P = 0.02; 95% CI, 1.01∼1.16) and repeat sternotomy (OR = 5.93; P < 0.01; 95% CI, 2.88∼12.25) were important risk factors for DSWI. Of the 134 patients with DSWI, 31 underwent the PMMF technique, and the remaining 103 served as controls. There were significant differences in coronary artery bypass grafting (CABG) (P < 0.01), valve replacement (P = 0.04) and repeat sternotomy (P < 0.01) between the case group and the control group. The postoperative extubation time (P < 0.001), ICU time (P < 0.001), total hospitalization time (P < 0.001) and postoperative hospitalization time (P < 0.001) in the PMMF group were significantly lower than those in the control group. The results of multivariate regression analysis showed that PMMF surgery was an important protective factor for the postoperative survival of DSWI patients (OR = 0.12; P = 0.04; 95% CI, 0.01∼0.90).ConclusionsStaphylococcus aureus was the most common bacteria causing DSWI, which was associated with BMI and reoperation, and can be validly treated with PMMF.

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“…В частности, S. Kim и соавт. [4] сообщают об отсроченном разрыве аорты. Общая летальность, ассоциированная с поверхностной стернальной инфекцией, варьирует от 0,5 до 4,4% [5].…”

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Air-plasma flow for postoperative sternal infection management

Lednev¹,

Belov²,

Marakhonich³

et al. 2017

Kardiol. serdechno-sosud. khir.

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Цель исследования-изучение возможности использования воздушно-плазменного потока аппарата Плазон для лечения поверхностной стернальной раневой инфекции у кардиохирургических больных с оценкой ближайших результатов лечения. Материал и методы. Аппарат Плазон для лечения раневых осложнений кардиохирургических вмешательств был использован у 7 пациентов (6 мужчин и 1 женщина, средний возраст 57,3±10,1 года). Все хирургические вмешательства на сердце осуществлены в плановом порядке. Из них коронарное шунтирование выполнено 3 (42,9%) пациентам, изолированное протезирование аортального клапана-1 (14,3%), симультанное коронарное шунтирование и протезирование аортального клапана-2 (28,6%), операция Бенталла-1 (14,3%) пациенту. Поверхностная стернальная раневая инфекция развилась через 8,3±5,3 сут послеоперационного периода. Для местного лечения раневой инфекции использован воздушно-плазменный поток, получаемый и подаваемый к ткани раневой поверхности, при помощи аппарата Плазон. Обработка раневой поверхности воздушно-плазменным потоком начиналась с момента снятия швов с кожи и подкожной жировой клетчатки послеоперационной раны и выполнялась 1 раз в сутки. Воздействие проводилось в режиме щадящей стерилизации. Среднее количество сеансов обработки раневой поверхности до наложения вторичных швов составило 5,9±0,7. После полного очищения раны и появления активной грануляционной ткани накладывали вторичные швы, интраоперационно обрабатывая рану воздушно-плазменным потоком в режиме жесткой стерилизации до наложения швов и в режиме нежной стерилизации паравульнарно после их наложения. В послеоперационном периоде паравульнарная обработка послеоперационного шва продолжена в режиме биологической стимуляции (NO-терапии). Среднее количество процедур воздействия аппарата Плазон в послеоперационном периоде составило 5,9±1,1. Пациенты получали антибактериальную терапию до снятия швов (на 14-е сутки после их наложения). Дренажи удаляли в тот же день. Результаты. Эффективность лечения аппаратом Плазон оценивалась по переходу фазы экссудации в фазу регенерации (появление грануляций) раневого процесса. Рост островков грануляций отмечен на 3,0±0,6 сут после начала лечения воздушно-плазменным потоком. Раневая поверхность полностью очистилась и покрылась активной грануляционной тканью на 5,9±0,7 сут. Исследование микробной обсемененности раны на 5-е сутки после начала лечения свидетельствовало об отсутствии раневой микрофлоры у 100% пациентов исследования. Период лечения воздушно-плазменным потоком до наложения вторичных швов составил 6,9±0,7 сут. Средний срок пребывания больных в стационаре после повторного хирургического вмешательства насчитывал 6,9±1,1 сут. При этом пациентам в послеоперационном периоде паравульнарная обработка воздушно-плазменным потоком выполнена 5,9±1,1 раза. Выводы. Использование NO-содержащего воздушно-плазменного потока аппарата Плазон для лечения поверхностной стернальной инфекции возможно и позволяет сократить фазу экссудации раневого процесса, ускорить фазу пролиферации, сократить сроки лечения до и после наложения ...

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Delayed aortic rupture resulting from postoperative superficial sternal wound infection

Cited by 3 publications

References 7 publications

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Deep sternal wound infection and pectoralis major muscle flap reconstruction: A single-center 20-year retrospective study

Air-plasma flow for postoperative sternal infection management

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