Background Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Traditional treatment methods for DSWI include complete debridement, vacuum sealing drainage wound therapy and sometimes transposition of muscle flap. This study aimed to evaluate the utility of antibiotic-loaded bone cement combined with vacuum sealing drainage on DSWI and explore the effect of this treatment on lung function. Methods Between January 2018 and December 2019, we treated 12 patients suffering a mediastinitis and open thorax using antibiotic-loaded bone cement combined with vacuum sealing drainage. Subsequently, the blood and local concentration of antibiotic were measured. The patient characteristics, pulmonary function, were retrospectively analyzed. Subjects were followed up for 12 months. Results There were no intraoperative deaths. All patients’ healing wounds were first-stage healing without complications and reoperation, the mean hospital stay was 20.2 ± 3.5 days. Local vancomycin concentrations largely exceeded the ones needed for their efficacy while little antibiotic was found in the blood. Pulmonary function testing was improved 2 weeks after the operation. No infection reoccurred in12-month follow-up. Conclusions The antibiotic-loaded bone cement combined with vacuum sealing drainage might be an effective method for the sternal reconstruction of deep sternal wound infection and it can improve the patient's lung function in a short time.
Background Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. Case presentation This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient’s wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. Conclusions The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.
BackgroundDiabetic foot osteomyelitis (DFO) is serious chronic complication that causes disability or death in diabetic patients. Antibiotic-loaded bone cement is an effective sustained-release system for the treatment of chronic osteomyelitis and induces biofilm formation. This study aimed to valuate the outcomes and summarize the experiences of bone cement loaded with vancomycin combined with other comprehensive interventions in the treatment of DFO.MethodsOne hundred and twelve involved feet in 93 patients (43–92 years old) with DFO treated with antibiotic-loaded bone cement combined with other comprehensive interventions were retrospectively analyzed. The durations of oral and intravenous antibiotics and hospitalization, ulcer healing times, recurrence and rehospitalization rates, and the rates of amputation above the ankle were evaluated at the last follow-up. One hundred and forty four pathogenic bacteria were co-cultured from the secretions of deep wounds from foot ulcers. The Maryland criteria were used to evaluate the recoveries of foot functions. ResultsEighty seven patients with 105 involved feet were followed up successfully over an average period of 14 months. All wounds exhibited good union on follow up, and DFO was cured. The average durations of oral and intravenous antibiotic administrations were 12.2 ± 1.5 and 10.8 ± 2.5 days, respectively. The average duration of hospitalization was 14.0 ± 2.7 days and the healing time for the ulcers was 37.8 ± 6.3 days. Rehospitalization presented in 21 (18.8%) foot ulcers among those with ulcer recurrence. No patients required amputation above the ankle. According to the Maryland criteria, 31, 45, 26, and three feet were rated as excellent, good, fair, and failures, respectively. Overall, 72% were rated as excellent-good. ConclusionsThe rate of amputation above the ankle was significantly reduced with the use of comprehensive interventions to retain foot function and improve quality of life. This management strategy in the treatment of DFO is effective and comprehensive comprehensive; therefore, it should be more frequently used in clinical settings.
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