Impact of Vacuum-Assisted Closure (VAC) Therapy on Clinical Outcomes of Patients with Sternal Wound Infections: A Meta-Analysis of Non-Randomized Studies

Falagas, Matthew E.; Tansarli, Giannoula S.; Kapaskelis, Anastasios; Vardakas, Konstantinos Z.

doi:10.1371/journal.pone.0064741

Cited by 38 publications

(32 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, complications occurred in up to 18% of patients treated with this approach [16,92] . Several recent studies, meta-analyses, and systematic reviews have validated the efficacy of NPWT in DSWI either as a single-line therapy, or as a "bridge" prior to final surgical closure [93][94][95][96][97] . 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] .…”

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

“…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] . 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] .…”

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

“…It has also been shown to positively influence time to healing in high risk wounds when compared with conventional remedies in an early phase of treatment . An enormous amount of clinical data on various cohort studies, case series, and meta‐analyses have been reported in the literature claiming various positive clinical effects of topical negative pressure therapy on open and complicated wounds . It has been reported to reduce the number of dressing changes, patient‐related pain, and the length of hospital stay and also to alter molecular mechanisms at the genetic level .…”

Section: Introductionmentioning

confidence: 99%

Negative pressure wound treatment with computer‐controlled irrigation/instillation decreases bacterial load in contaminated wounds and facilitates wound closure

Ludolph

Fried

Kneppe

et al. 2018

International Wound Journal

View full text Add to dashboard Cite

Microbial wound contamination is known to be a hindrance to wound healing. Negative pressure wound therapy (NPWT) with or without irrigation is known to optimise conditions in problem wounds. The aim of this study was to investigate the influence of computer-controlled wound irrigation with NPWT on the bacterial load in contaminated wounds. A total of 267 patients were treated with NPWT with automated instillation because of problematic wounds using an antiseptic instillation solution. In 111 patients, a minimum of 4 operative procedures were necessary, and swabs were taken at least at the first and at the fourth operation in a standardised procedure. The number of different bacteria and the amount of bacteria were analysed during the course. In a subgroup of 51 patients, swabs were taken at all 4 operative procedures and analysed separately. In an overall analysis, the number of different bacteria and the amount of bacteria significantly decreased independent of wound localisation and diagnosis. NPWT with automated instillation demonstrates a positive influence in the reduction of bacterial load in problem wounds. Thus, it may help to optimise wound conditions before definite wound closure.

show abstract

“…6,[18][19][20] In these reports, the sternum was debrided, re-sutured, re-wired, or left open and covered with the muscle flaps. More recently, the addition of negative pressure wound pressure therapy [21][22][23][24][25][26][27] 10 muscles as a single myocutaneous unit. There is a suggestion in the adult literature that the use of pectoralis major muscle advancement flaps alone leads to decreased shoulder strength when measured objectively.…”

Section: Discussionmentioning

confidence: 99%