Prospective Trial of Catheter Irrigation and Muscle Flaps for Sternal Wound Infection

Rand, Richard P.; Cochran, Richard P.; Aziz, Salim; Hofer, Bradley O.; Allen, Margaret D.; Verrier, Edward D.; Kunzelman, Karyn S.

doi:10.1016/s0003-4975(98)00087-3

Cited by 84 publications

(46 citation statements)

References 11 publications

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“…Several case series have examined the use of BPMMF 4,26 or VAC closure 10,11 in patients with DSWI. However, only one randomized, controlled clinical trial comparing catheter irrigation and muscle fl aps has been reported, 5 which is not surprising given the diffi culty of performing meaningful studies on such rare and heterogeneous complications. The trend in our practice since 2000 has been toward single-stage closure using BPMMF reconstruction and continuous irrigation for patients with osteomyelitis or sternal destruction.…”

Section: Discussionmentioning

confidence: 99%

“…4 A prospective randomized trial by Rand et al revealed a better outcome after muscle fl ap repair than after closed-chest catheter irrigation in patients with DSWI. 5 The use of subatmospheric pressure in the wound environment for tissue repair with vacuum-assisted closure (VAC) was devised in 1997 by Morykwas et al 6 for chronic debilitating wounds. In 1999, Obdeijn et al 7 expanded the use of VAC therapy to include poststernotomy mediastinitis.…”

Section: Introductionmentioning

confidence: 99%

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Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

et al. 2009

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“…An important step forward in the treatment of DSWI occurred with the introduction of continuous irrigation using closed chest catheter following revision. Further developments were achieved with antibiotic irrigation but several studies have reported high rates of failure and mortality [82][83][84] . The unsatisfactory results of these different approaches increased interest in plastic procedures as alternative treatments [6,79,84] .…”

Section: Managementmentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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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 ...

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“…The incidence of sternal dehiscence was reported to be 0.5% to 8% depending on the presence of a mechanical defect, and type and degree of the infection. [6] In addition, several techniques have been described for the sternal closure. This study was conducted to investigate whether a sternal cable could be an alternative to the sternal wire.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the sternal wires and sternal cable in closure of the sternum during cardiac surgery

Özen¹

2015

Cardiovasc Surg Int

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Objectives: This study aims to compare the effectiveness of the sternal cable system (Cable group) with the standard monofilament system (Wire group) in the sternal closure of cardiac surgery patients. Patients and methods:Between January 2014 and September 2014, a total of 56 patients were included. The patients were divided into two groups according to the closure modality. The Cable group in whom the sternal cables were used consisted 24 patients, whereas the Wire group included 32 patients. Risk factors such as obesity, chronic obstructive pulmonary disease, diabetes mellitus, reoperation and closure with figure-of-8 were considered in the selection of these patients. The length of intensive care unit and hospital stay, blood drainage, infection and sternal complications were compared between the groups.Results: Preoperative and perioperative variables between two groups were similar. There was no postoperative sternal complications for the Cable group, however, sternal dehiscence and superficial wound infections were observed in two patients in the Wire group. An inflammatory reaction to the wire developed within one month in a patient. Conclusion:We recommend using sternal cable system instead of wires in the patients having risk factors for sternal instability.

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Prospective Trial of Catheter Irrigation and Muscle Flaps for Sternal Wound Infection

Cited by 84 publications

References 11 publications

Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Comparison of the sternal wires and sternal cable in closure of the sternum during cardiac surgery

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