Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: The value of supportive thorax vests

Abstract

The Robicsek technique for sternal closure and the use of a thorax support vest postoperatively are highly effective in preventing sternal dehiscence after cardiac surgery in patients with moderate and severe chronic obstructive pulmonary disease.

Risk factors for surgical site infection in cardiac surgery

“…The prevalence of male gender was corroborated by other studies about patients who underwent cardiac surgery (10,12,16,18,19,26,27) . Regarding the higher incidence of SSI in male patients, this result is close to the findings of other studies (14,28,29) .…”

“…Therefore, identifying and treating existing infectious site before elective surgeries is a recommendation and their rescheduling should only be done after the resolution of the problem, ie, control of infectious site (4) . Although some risk factors such as DM and COPD, are widely discussed in the literature as strong predictors for SSI (8)(9)(10)(11)(12)(13) ; in this study they were not associated with the occurrence of SSI. However, we must remember that prevention and control measures are essential and are directly related to the postoperatively prognosis (8,9,17,22,25) .…”

“…Regarding transoperative period, in which there is exposure and manipulation of the tissue, during this period the entry of microorganisms is favored in the surgical site due to the existence of sources of infection, which may be endogenous (age, baseline disease) or exogenous (breaking aseptic barrier, inadequate hand hygiene) (7) . According to literature, several factors may contribute to the occurrence of SSI, among them: diabetes mellitus (DM), obesity (8)(9)(10) , obstructive pulmonary disease (OPD) (11)(12)(13) , age (11.14 ) , female gender (8.15) , sternal reexploration for bleeding (10,16,17) , blood transfusion (17,18) , duration of preoperative hospitalization (4.14) , inadequate hand hygiene (4, 7.19) , among others, as the use of prophylactic antibiotic at the right time (4.19) , clinical condition of the patient, prolonged surgery time and number of professionals in the operating room (19) . The identification of risk factors that contribute to the SSI occurrence, can provide information for planning and adoption of strategies in the prevention, control and monitoring of the infection in order to minimize their occurrence and maximize the principles of patient safety.…”

Sternal wrapping: developments and results

“…8 Supportive thorax vests and counseling also help to prevent mechanical sternal failure. 9 Our experience and that of others suggests that SW also has positive effects on sternal wound healing, reducing PSWC incidence and severity. In particular, SW seems to increase sternal resistance to osteomyelitis.…”

Effects of Polyglyconate (Maxon) Suture Reinforced Sternum Closure Technique on Aseptic Sternal Dehiscence in High Risk Patients

“…incidence of this complication is 2.5% and increases up to 5.6% in patients with at least one risk factor such as obesity, advanced age, diabetes, COPD and prolonged extracorporeal circulation and mechanical ventilation (1,2) . Thus, reinforced sternal closure for prevention of sternal dehiscence in high-risk patients is necessary (3)(4)(5)(6) .…”