Negative pressure wound therapy in the treatment of deep sternal wound infections – a critical appraisal

Myllykangas, Heidi-Mari; Berg, Leena; Husso, Annastina; Halonen, Jari

doi:10.1080/14017431.2021.1955963

Cited by 5 publications

(13 citation statements)

References 30 publications

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“…Among the 492 screened articles, a total of 4 studies were included in the present analysis. [7][8][9]13 A total of 438 patients were included in the pooled analysis. Overall, 229 patients had immediate flap reconstruction, and 209 patients were performed NPWT.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Three cohort studies involving 309 participants reported in-hospital mortality. 7,8,13 Meta-analysis with fixed-effects model indicated that compared with…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…Four cohort studies involving 438 participants reported LOS. [7][8][9]13 Outcomes of Tuo et al and E. Hamalainen et al reported as medians and interquartile ranges were transformed to means and standard deviations. 7,9,11,12 Meta-analysis with random-effects model indicated that compared with NPWT, immediate flap significantly reduced LOS (SMD À13.24, 95% CI À20.53 to À5.94, P = .0004) (Figure 4).…”

Section: Losmentioning

confidence: 99%

“…5,6 However, recent studies have shown that debridement combined with early flap reconstruction has better outcomes compared with NPWT. [7][8][9] Therefore, a meta-analysis was performed to evaluate the effects of immediate flap and NPWT on mortality and length of hospital stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

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Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Qiu

Sun

Huang

2023

International Wound Journal

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Deep sternal wound infection is a severe complication after cardiac surgery. We performed a meta‐analysis evaluating the impact of immediate flap and NPWT on mortality and length of hospital stay. The meta‐analysis was registered (CRD42022351755). A systematic literature search was conducted from inception to January, 2023, including PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov and EU Clinical Trials Register. The main outcome were in‐hospital mortality and late mortality. And additional outcomes were length of stay and ICU stay time. A total of 438 patients (Immediate flap: 229; NPWT: 209) from four studies were included in this study. Immediate flap was associated with lower in‐hospital mortality (OR 0.33, 95% CI 0.13‐0.81, P = .02) and length of stay (SMD −13.24, 95% CI −20.53 to −5.94, P = .0004). Moreover, pooled analysis demonstrated no significant difference was found in two groups in terms of late mortality (OR 0.64, 95% CI 0.35‐1.16, P = .14) and ICU stay time (SMD −1.65, 95% CI −4.13 to 0.83, P = .19). Immediate flap could reduce in‐hospital mortality and length of stay for patients with deep sternal wound infection. Flap transplantation as soon as possible may be advised.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Three cohort studies involving 309 participants reported in-hospital mortality. 7,8,13 Meta-analysis with fixed-effects model indicated that compared with…”

Section: In-hospital Mortalitymentioning

confidence: 99%

Section: Losmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Qiu

Sun

Huang

2023

International Wound Journal

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“…Yoshimoto and colleagues, 17 compared NPWT with standard therapy of wound debridement, dressings and delayed flap closure and concluded that patients undergoing NPWT had reduced hospital stay and achieved negative tissue cultures in reduced time. Myllykangas et al 18 reported that NPWT decreased the time between debridement and complete wound closure. Petzina et al 19 in their retrospective analysis of 118 patients, found that mortality with NPWT was 6% compared with 25% in patients who underwent debridement and dressings change without NPWT.…”

Section: Discussionmentioning

confidence: 99%

Management Outcome of Patients with Infected Sternotomy Wounds

Shabbir

Sarwar

Rashid

et al. 2023

PAFMJ

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Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Preoperatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional well being 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol.

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Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis

Liu,

Lin,

Peng

et al. 2024

International Journal of Surgery

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Background: Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, we aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. Material and Methods: A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and intensive care unit stay. Results: In this systematic review identified a total of 36 studies, comprising 3,681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI 0.35-0.61, P<0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14, -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18, -0.04; P=0.04). Conclusion: This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.

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Negative pressure wound therapy in the treatment of deep sternal wound infections – a critical appraisal

Cited by 5 publications

References 30 publications

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Management Outcome of Patients with Infected Sternotomy Wounds

Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis

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