Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis

Morisaki, Akimasa; Hosono, Mitsuharu; Murakami, Takashi; Sakaguchi, Masanori; Suehiro, Yasuo; Nishimura, Shinsuke; Sakon, Yoshito; Yasumizu, Daisuke; Kawase, T.; Shibata, Toshihiko

doi:10.1093/icvts/ivw141

Cited by 40 publications

(53 citation statements)

References 23 publications

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“…Negative pressure wound therapy (NPWT) applies subatmospheric pressure to the surface of wound, removes excessive fluid, decreases wound edema, accelerates wound healing and granulation tissue formation, stabilises chest wall, increases sternal blood flow and has been shown to improve early and long term survival in patients with deep sternal wound infection. It has emerged as one of the most significant developments in the last two decades in the management of sternal wound infections [ 31 , 32 ]. All deep sternal wound infections and all limited sternal wound dehiscences not resulting in frank sternal instability should be treated in the first instance with negative pressure wound therapy and antibiotics.…”

Section: Reviewmentioning

confidence: 99%

“…In DSWI infected with MRSA, in particular, NPWT significantly reduced in-hospital mortality caused by DSWI (0 vs 52%, P = 0.003). Equally importantly, NPWT as a bridge therapy to tissue flaps may play a major role in treating DSWI and improve prognosis for patients with MRSA-infected sternal wounds [ 31 ]. Debreceni et al reported on 62 consecutive patients who underwent vacuum assisted wound closure (VAC).…”

Section: Reviewmentioning

confidence: 99%

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Sternal reconstruction after post-sternotomy mediastinitis

Kaul

2017

J Cardiothorac Surg

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BackgroundDeep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text.Methodology and reviewThis article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented.ConclusionsDeep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Sternal reconstruction after post-sternotomy mediastinitis

Kaul

2017

J Cardiothorac Surg

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“…It is worth noting that the deaths identified were not related to the therapy used, but to the severity of the infection. Consistent with these data, a retrospective observational study 19 evaluated the vacuum treatment for mediastinitis, and concluded that mortality rates were lower when compared to conventional treatment, and that by associating the vacuum with the use of flaps, the results were even better.…”

Section: Discussionmentioning

confidence: 73%

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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“…NPWT increases blood flow in the applied area and thus works in favor of any flap tissue remaining even though partially lost. This gives an opportunity to use the same flap to close the wound in most cases 6 , 10 . So, on the basis of this case, it can be suggested that the usage of NPWT promotes wound healing and contributes to the flap survival in the presence of infection and flap dehiscence in recurrent pilonidal disease.…”

Section: Discussionmentioning

confidence: 99%

MANAGEMENT OF FLAP DEHISCENCE AFTER LıMBERG PROCEDURE FOR RECURRENT PıLONıDAL DıSEASE BY NEGATıVE PRESSURE WOUND THERAPY (NPWT)

Taş

Özkan

Ocakli

et al. 2017

ABCD, arq. bras. cir. dig.

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Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis

Abstract: NPWT and tissue flaps may be favourable factors associated with reduced in-hospital mortality attributable to DSWI. NPWT as a bridge therapy to tissue flaps may play a major role in treating DSWI and improve the prognosis for patients with MRSA-infected DSWI.

Cited by 40 publications

References 23 publications

Sternal reconstruction after post-sternotomy mediastinitis

Sternal reconstruction after post-sternotomy mediastinitis

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

MANAGEMENT OF FLAP DEHISCENCE AFTER LıMBERG PROCEDURE FOR RECURRENT PıLONıDAL DıSEASE BY NEGATıVE PRESSURE WOUND THERAPY (NPWT)

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