Assessment of vacuum‐assisted closure therapy on the wound healing process in cardiac surgery

Pericleous, Agamemnon; Dimitrakakis, Georgios; Photiades, Renos; Oppell, Ulrich O. von

doi:10.1111/iwj.12430

Cited by 11 publications

(16 citation statements)

References 37 publications

(51 reference statements)

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“…Gdalevitch et al [107] found that positive blood cultures, wound depth of ≥ 4 cm, and high degree of bony exposure and sternal instability are significant predictors of NPWT failure. Pericleous et al [108] highlighted also the importance of lung emphysema, corticosteroids, and advanced age. Finally, Gustafsson et al [109] stressed bacteremia or elevated plasma C-reactive protein levels as the most sensitive predictors of failure.…”

Section: Antimicrobial Prophylaxismentioning

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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Section: Antimicrobial Prophylaxismentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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“…Regarding the methodological delineations found, six (75%) were retrospective observational studies, and two (25%) cohort studies. [10][11][12][13][14][15][16][17] Six articles have similar methodological characteristics, being A1, A2, A3, A4, A5, and A8 retrospective observational studies, and two (A6 and A7) retrospective cohort studies. The analysis of the results showed three therapies used in the treatment of mediastinitis after cardiac surgery, being: Negative Pressure Wound Therapy (NPWT), also known as vacuum assisted therapy; conventional treatment; and drainage by closed system.…”

Section: /16mentioning

confidence: 99%

“…The analysis of the results showed three therapies used in the treatment of mediastinitis after cardiac surgery, being: Negative Pressure Wound Therapy (NPWT), also known as vacuum assisted therapy; conventional treatment; and drainage by closed system. [10][11][12][13][14][15][16][17] adjusted in -125 mmHg versus conventional dressing (chlorhexidine or paraffin). Infection: in the conventional group, eight patients required surgical review for reinfections.…”

Section: /16mentioning

confidence: 99%

“…Only Article A7 described the name of the material used as GranuFoam™. [10][11][12][13][14][15][16][17] Three articles (37.5% of the sample), namely A1, A3 and A5, used Vacuum NPWT as the only choice in the treatment of mediastinitis, while five (62.5%) adopted the method of comparison between therapies (A2, A4, A6, A7 e A8). [10][11][12][13][14][15][16][17] In A1, 34 patients diagnosed with mediastinitis and submitted to NPWT were analyzed.…”

Section: A8 17mentioning

confidence: 99%

“…Of the 52 patients, 35 were male (67.03%) and 17 were female (32.07%), with an average age of 68.13 years, ranging from 47 to 82 years. 14 The microbiology of sternal infections showed the following pathogens: Staphylococcus coagulase-negative (31.5%), Coliforms (27.4%), Coryneform (15.3%), Serratia marcescens (7.3%), non-hemolytic Streptococcus (7.3%), Pseudomonas spp. (6.5%), Staphylococcus aureus (4.8%), and Methicillin-resistant Staphylococcus aureus (0.8%).…”

Section: /16mentioning

confidence: 99%

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Dressings Indicated in the Treatment of Mediastinitis After Cardiac Surgery: Integrative Review

Frantz

Stocco

Ribeiro

et al. 2019

Texto contexto - enferm.

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Objective: identify and describe which dressings are recommended in the treatment of mediastinitis after cardiac surgery in adult patients. Method: integrative review held in the databases MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane, SCOPUS and manual search, between December 2017 and January 2018. It was selected studies on dressings used in the treatment of mediastinitis after cardiac surgery. Results: eight articles were included: three addressed the treatment of negative pressure wounds and reported that most of the patients analyzed were successful in treatment, reducing the need for other interventions; four compared the previous therapy with conventional dressings and concluded that the rates of sternal reinfection and hospital mortality were lower in the first group; and one compared vacuum assisted therapy with a closed drainage system and lower rates of sternal reinfection were seen in the group undergoing vacuum treatment. Conclusion: the evidence indicates that the use of vacuum therapy to treat mediastinitis after cardiac surgery was effective. However, despite the positive outcome, clinical trials with strict methodological description and significant samples are suggested to minimize the risk of bias and to evaluate the impact of dressings in the treatment of mediastinitis.

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Deep Sternal Wound Infection After Cardiac Surgery

Kubota¹,

Ohura²

2018

Recent Clinical Techniques, Results, and Research in Wounds

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Background: Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. Methods: We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as inhospital or 30-day mortality. Risk factors for DSWI were also examined. Results: The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups.

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Assessment of vacuum‐assisted closure therapy on the wound healing process in cardiac surgery

Cited by 11 publications

References 37 publications

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Dressings Indicated in the Treatment of Mediastinitis After Cardiac Surgery: Integrative Review

Deep Sternal Wound Infection After Cardiac Surgery

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