Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing

Vos, Roemer J.; Yilmaz, Alaaddin; Sonker, Uday; Kelder, Johannes C.; Kloppenburg, Geoffrey T.L.

doi:10.1093/icvts/ivr049

Cited by 45 publications

(53 citation statements)

References 15 publications

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“…This wound-healing technique is based on the application of continuous or intermittent negative pressure to a wound, which results in arteriolar dilatation and, subsequently, determines wound perfusion and granulation tissue proliferation [57,85,93] . In vitro and clinical studies designed to determine the effect of NPWT lent convincing evidence of efficacy and safety in term of decrease of edema, exudation, and microbial colonization as well as reduction of inflammatory cytokine release [57,85,[98][99][100] . In case of diagnosis of DSWI, an early application of NPWT was associated to a faster healing and an increased likelihood of survival [18,97,101,102] .…”

Section: Antimicrobial Prophylaxismentioning

confidence: 99%

“…In case of diagnosis of DSWI, an early application of NPWT was associated to a faster healing and an increased likelihood of survival [18,97,101,102] . Moreover, several studies demonstrated shorter treatment duration and length of hospital stay, as well as lower costs in patients treated with NPWT [96,98,100,103] . NPWT was also successfully applied in the case of MRSA mediastinitis and as a temporizing treatment prior to secondary closure in mediastinitis due to Candida [90,104,105] .…”

mentioning

confidence: 99%

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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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Section: Antimicrobial Prophylaxismentioning

confidence: 99%

mentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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“…The incidence rate of mediastinitis has been reported to be 0.3-5% [7][8][9][10]. Mediastinitis after sternotomy is a severe complication, even in paediatric patients, and its treatment remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…The following surgical treatments for mediastinitis have been reported: closed irrigation [11], muscle flaps [9], primary closure with drainage [12] and VAC [7,13,14].…”

Section: S Takahara Et Al / Interactive Cardiovascular and Thoracicmentioning

confidence: 99%

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Takahara

Kagatani

et al. 2014

Interact CardioVasc Thorac Surg

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OBJECTIVES: Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis. METHODS:Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation. RESULTS:The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively). CONCLUSIONS:In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.

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“…Besides an improved local perfusionand oxygenation, the quantitative bacterial florais rapidly reduced and the formation of scar tissue is stimulated. Several studies showed the benefits of a VAC therapy in terms of shorter hospitalizations, earlier secondary wound closure and a lower mortality compared to conventional therapy [9,10]. We used VAC therapy to treat our patients with mediasitinitis.…”

Section: Discussionmentioning

confidence: 99%

Early Repair of Sternal Instability Prevents Mediastinitis

Aykut¹,

Albayrak²,

Kavala³

et al. 2014

WJCS

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Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

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Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing

Cited by 45 publications

References 15 publications

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Early Repair of Sternal Instability Prevents Mediastinitis

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