Negative pressure wound therapy for sternal wound infections following congenital heart surgery

Costello, John P.; Amling, June K.; Emerson, Dominic; Peer, Syed Murfad; Afflu, Derek; Zurakowski, David; Jonas, Richard A.; Nath, Dilip S.

doi:10.12968/jowc.2014.23.1.31

Cited by 17 publications

(27 citation statements)

References 15 publications

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“…The results of the present study suggested that the early use of NPWT rapidly following wound contamination may be more effective than delayed application in impeding biofilm formation. These results are concordant with those of previous studies that have demonstrated a satisfactory efficacy of NPWT on managing acute wounds with contamination when initiated early ( 33 – 36 ). Although further investigations are required in order to clarify the role of biofilm matrix reduction in wound care, the present study provides a possible mechanism of action for this therapy.…”

Section: Discussionsupporting

confidence: 92%

“…Physical therapies have emerged in biofilm management due to their satisfactory efficacy and low risk for microbial resistance ( 32 ). In particular, negative pressure wound therapy (NPWT) has been shown to improve the healing process of infected wounds and to avoid biofilm-associated infections when applied as early as possible ( 33 – 38 ). Previous studies have attributed these benefits to the secondary effects of NPWT, including fluid removal, modulation of inflammation, and the stimulation of wound healing signaling pathways ( 38 – 41 ).…”

Section: Introductionmentioning

confidence: 99%

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Early application of negative pressure wound therapy to acute wounds contaminated with Staphylococcus aureus: An effective approach to preventing biofilm formation

Zhang

Han

et al. 2016

Experimental and Therapeutic Medicine

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Negative pressure wound therapy (NPWT) has been demonstrated to be effective at preventing biofilm-associated infections; however, its role in biofilm prevention is unknown. The present study evaluated the effect of NPWT on biofilm prevention when rapidly initiated following wound contamination. Full-thickness dermal wounds (8 mm) were created in rabbit ears and inoculated with green fluorescent protein-labeled Staphylococcus aureus (S. aureus). At 6 h following inoculation, continuous NPWT at −125 mmHg was initiated, with the wounds on the contralateral ear left untreated in order to serve as self-controls. S. aureus rapidly formed mature biofilms in the wound beds post-inoculation, with a persistent bacterial burden of ~105−107 colony-forming units (CFUs)/wound and impaired wound healing. Compared with the untreated group, NPWT resulted in a significant reduction in biofilm matrix, which was verified by scanning electron microscopy and epifluorescence. A reduction in bacterial counts followed (P<0.05) with ~103 CFUs/wound on postoperative day 13 and improvement in all healing parameters (P<0.05) relative to control wounds. The results of the present investigation suggest that NPWT is an effective strategy to impeding the formation of S. aureus wound biofilms when initiated rapidly following bacterial contamination. The early application of NPWT, aimed at biofilm prevention, may improve wound care.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Early application of negative pressure wound therapy to acute wounds contaminated with Staphylococcus aureus: An effective approach to preventing biofilm formation

Zhang

Han

et al. 2016

Experimental and Therapeutic Medicine

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“…These factors increase the risk of mediastinitis . The diagnosis criteria of mediastinitis vary from institution to institution as well as between individual clinicians . Microbiological cultures of the wounds show a wide variety of organisms such as Staphylococcus aureus (both MRSA and MSSA), Staphylococcus epidermidis , coagulase‐negative Staphylococcus , Escherichia coli , enterococcus species, Klebsiella pneumonia , Pseudomonas aeruginosa , Proteus vulgaris , Corynebacterium , Serratia marcescens , and Acinetobacter baumannii .…”

Section: Discussionmentioning

confidence: 99%

Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience

et al. 2018

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Vacuum‐assisted closure (VAC) has been widely used to treat mediastinitis after congenital cardiac surgery, which is associated with a high risk of morbidity and mortality. The aim in this study is to review our 14 cases of mediastinitis treated with VAC therapy after congenital cardiac surgery. We retrospectively reviewed the medical records of 14 congenital heart patients with mediastinitis from January 2012 to March 2017. Patients with fever, wound discharge, sternal dehiscence, a positive wound culture or abscess diagnosed with computed tomography are accepted as mediastinitis. A VAC was applied to all our patients without irrigation or dressing the wound because of sterility concerns. The vacuuming of the wound was either 50 mm Hg or 75 mm Hg according to the sternal intactness. We gradually decreased the pressures and changed the VAC systems once every three days, after wound healing was seen and a negative culture was obtained and VAC was terminated. There were 14 patients (8 male and 6 female) with mediastinitis and all of them were treated using VAC. The mean age of the patients was 6.96 months (ranging from 0.5‐26 months). The mean weight was 5.16 kg (2.8‐12 kg). Three patients needed extracorporeal membrane oxygenation after the surgery. Mean onset of mediastinitis was 25.3 days. The wound cultures showed methicillin resistant coagulase negative streptococcus and methicillin‐sensitive staphylococcus aureus in most cases. Acinetobacter, serratia, pseudomonas, and klebsiella were the other bacterial species seen in cultures. Two patients had mediastinitis symptoms, but their cultures were negative. VAC systems were changed 3.85 times on average. Mean duration of hospital stay was 49.9 days (21‐104 days). One patient needed a muscle flap to close the thoracic cavity after mediastinitis. Two patients did not survive. Mediastinitis is a serious postoperative condition in pediatric cardiac surgery patients. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group. Therefore, VAC therapy can be an effective way to successfully treat the situation.

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“…Furthermore, several author groups have attempted to reduce the SSI rate by utilising new techniques or devices like new suture techniques and products, including antibiotic‐coated sutures, silver‐impregnated dressings, antiseptic wound irrigation and iodine‐impregnated skin drapes – very often without a high‐quality evidence level . Additionally, some authors tried to reduce the SSI rate by organisational measures like the implementation of a comprehensive, multidisciplinary wound management team , yet continued high SSI rates demonstrate the need for further preventative methods. Traditionally, surgeons have closed surgical incisions with primary intention using sutures, staples, tissue adhesives or a combination of these methods.…”

Section: Introductionmentioning

confidence: 99%

The impact of surgical site occurrences and the role of closed incision negative pressure therapy

Willy

Engelhardt

Stichling

et al. 2016

International Wound Journal

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Surgical site occurrences are observed in up to 60% of inpatient surgical procedures in industrialised countries. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. Literature reviews ('SSI', 'deep sternal wound infections' (DSWI), 'closed incision negative pressure wound therapy' (ciNPT) were performed by electronically searching MEDLINE (PubMed) and subsequently using a 'snowball' method of continued searches of the references in the identified publications. Search criteria included publications in all languages, various study types and publication in a peer-reviewed journal. The SSI literature search identified 1325, the DSWI search 590 and the ciNPT search 103 publications that fulfilled the search criteria. Patient-related SSI risk factors (diabetes mellitus, obesity, smoking, hypertension, female gender) and operation-related SSI risk factors (re-exploration, emergency operations, prolonged ventilation, prolonged operation duration) exist. We found that patient-and operation-related SSI risk factors were often different for each speciality and/or operative procedure. Based on the evidence, we found that high-risk incisions (sternotomy and incisions in extremities after high-energy open trauma) are principally recommended for ciNPT use. In 'lower'-risk incisions, the addition of patient-related or operation-related risk factors justifies the application of ciNPT.

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Negative pressure wound therapy for sternal wound infections following congenital heart surgery

Cited by 17 publications

References 15 publications

Early application of negative pressure wound therapy to acute wounds contaminated with Staphylococcus aureus: An effective approach to preventing biofilm formation

Early application of negative pressure wound therapy to acute wounds contaminated with Staphylococcus aureus: An effective approach to preventing biofilm formation

Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience

The impact of surgical site occurrences and the role of closed incision negative pressure therapy

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