Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population

Franco, Sérgio; Herrera, Ana Milena; Atehortúa, Mauricio; Vélez, Luís Fernando; Castaño, Juan Carlos; Jaramillo, Juan S; Vélez, Juan Fernando; Fernandez, Hugo F.

doi:10.1510/icvts.2008.188136

Cited by 29 publications

(23 citation statements)

References 13 publications

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“…We performed a single center, retrospective review and had limited data on specifics about administration of systemic perioperative antibiotics. The frequency of DSWI declined over the study period with a notable decrease in the incidence between 2009 and 2010 (1.5% to 0.7%), probably due to implementation of updated STS antibiotic prophylaxis guidelines for cardiac surgery (5) and quality improvement campaigns for appropriate and timely administration of perioperative antibiotics, adoption of perioperative glucose management protocols (16), and patient-specific sternal closure techniques including double wires and sternal bands (17, 18). In addition, not all surgeons used vancomycin paste and there were changes in practice of the study period; however, we did not observe a relationship between individual surgeon and incidence of DSWI.…”

Section: Commentmentioning

confidence: 99%

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Lander

Ejiofor

McGurk

et al. 2017

The Annals of Thoracic Surgery

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Background Deep sternal wound infection (DSWI) is a devastating complication that increases morbidity and mortality in cardiac surgery patients. Vancomycin is often administered intravenously for antibiotic prophylaxis in cardiac surgery. Many cardiac surgeons also apply vancomycin paste topically to the sternal edges. We examined the effect of vancomycin paste upon the incidence of DSWI in patients undergoing elective cardiac surgery. Methods We performed a single institution, retrospective medical record review of all patients from 2003 to 2015 who underwent CABG, valve or CABG/valve surgery. We derived the Society for Thoracic Surgeons (STS) DSWI risk index for each patient and performed a systematic review of operative, pharmacy, microbiology and discharge records to identify patients that developed DSWI. Multivariate analyses were used to identify predictors of DSWI in this cohort and to quantify the effect of vancomycin paste. Results 14,492 patients were examined, of whom 136 patients developed DSWI, resulting in an overall incidence of 0.9%. After multivariate analysis, body mass index, NYHA class and STS DSWI risk index remained statistically significant and associated with DSWI. Although the incidence of DSWI decreased over time, the use of vancomycin paste was not associated with a reduced incidence of DSWI. Conclusions There was a marked decrease in the incidence of DSWI over the study period, concurrent with institutional implementation of revised STS antibiotic dosing guidelines in 2007 and other strategies. However, the application of vancomycin paste to the sternal edges of patients undergoing cardiac surgery was not associated with a reduced risk of DSWI.

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Section: Commentmentioning

confidence: 99%

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Lander

Ejiofor

McGurk

et al. 2017

The Annals of Thoracic Surgery

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“…Providing a more stable osteotomy and improving sternal osteosynthesis is the best way to prevent these complications [3,4,27,28] . More than 40 different techniques with various materials have been described for sternal closure [12][13][14][15][16] . Most techniques revolve around a different pattern of wire cerclage, rigid plate fixation, or various non-rigid methods of closure [29][30][31][32][33][34][35][36] .…”

Section: Discussionmentioning

confidence: 99%

“…Providing greater stability [3,4,6] and promoting primary osseous healing is crucial for preventing these complications [7][8][9][10][11] . More than 40 different techniques have been described for closing median sternotomy [12][13][14][15][16] . The biomechanical characteristics of different sternal closures may substantially improve sternotomy reduction and stability [17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

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AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

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“…The reported incidence of postoperative SWI varies considerably; because of differences in definitions and classification of infections and variations in follow-up [2,18-27]. Sternal wound infection (SWI) has a reported overall incidence between 0.5% and 6% [1].…”

Section: Reviewmentioning

confidence: 99%

“…Sternal wound infection (SWI) has a reported overall incidence between 0.5% and 6% [1]. However, in high-risk patients the incidence has been estimated at between 12 and 20% with an associated mortality rate between 14% and 47% [7,18-22]. Schersten et al suggest that the incidence of SSI goes higher in studies reporting surgery on high-risk patients and also in patients undergoing emergency operations [28].…”

Section: Reviewmentioning

confidence: 99%

Role of topical application of gentamicin containing collagen implants in cardiac surgery

Mishra¹,

Ashoub

Salhiyyah

et al. 2014

J Cardiothorac Surg

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Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.

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Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population

Cited by 29 publications

References 13 publications

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Role of topical application of gentamicin containing collagen implants in cardiac surgery

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