Effect of surgical incision management on wound infections in a poststernotomy patient population

Grauhan, O.; Navasardyan, Artashes; Tutkun, B; Hennig, Felix; Müller, Peter E.; Hummel, Manfred; Hetzer, Roland

doi:10.1111/iwj.12294

Cited by 63 publications

(87 citation statements)

References 9 publications

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“…Under the designation closed incision negative pressure therapy (ciNPT), this new technique has resulted in many significant clinical results (11,13,25,26). Since 2010, multiple studies and case reports comparing standard-of-care dressings to ciNPT have reported a decrease in SSIs in a wide spectrum of traumatic, orthopaedic, abdominal, sternal and plastic surgery incisions (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The reason for this success may be due to the reported mechanisms of action of the ciNPT, which protects the incision from external wound contamination, strengthens the cohesiveness of the wound edges, removes fluids and infectious materials from the wound, decreases the lateral tension around the incision and facilitates oxygen saturation and blood microcirculation within the incision area (11,38,39).…”

Section: Key Messagesmentioning

confidence: 99%

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

Pleger

Nink

Elzien

et al. 2017

International Wound Journal

135

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. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. Int Wound J 2018; 15:75-83 AbstractGroin wound infections in patients undergoing vascular procedures often cause a lengthy process of wound healing. Several clinical studies and case reports show a reduction of surgical site infections (SSIs) in various wound types after using closed incision negative pressure therapy (ciNPT). The aim of this prospective, randomised, single-institution study was to investigate the effectiveness of ciNPT (PREVENA™ Therapy) compared to conventional therapy on groin incisions after vascular surgery. From 1 February to 30 October 2015, 100 patients with 129 groin incisions were analysed. Patients were randomised and treated with either ciNPT (n = 58 groins) or the control dressing (n = 71 groins). ciNPT was applied intraoperatively and removed on days 5-7 postoperatively. The control group received a conventional adhesive plaster. Wound evaluation based on the Szilagyi classification took place postoperatively on days 5-7 and 30. Compared to the control group, the ciNPT group showed a significant reduction in wound complications (P < 0⋅0005) after both wound evaluation periods and in revision surgeries (P = 0⋅022) until 30 days postoperatively. Subgroup analysis revealed that ciNPT had a significant effect on almost all examined risk factors for wound healing. ciNPT significantly reduced the incidence of incision complications and revision procedures after vascular surgery.

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Section: Key Messagesmentioning

confidence: 99%

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

Pleger

Nink

Elzien

et al. 2017

International Wound Journal

135

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“…It delivers intermittent or continuous negative pressure (ranging from <50mmHg to >125mmHg) to the wound site which is covered with a foam or gauze dressing and sealed with an occlusive drape. Success has been reported in complex wounds 35 with emerging evidence to show that its use in high risk, post-operative incisions prevents SSIs [36][37][38][39][40] . The likely modes of action are through holding wound edges together (thereby reducing the likelihood of surgical dehiscence), stimulation of perfusion, reduction of lateral tension, haematoma and oedema, and protection of the surgical site from exogenous sources of micro-organisms.…”

Section: Negative Pressure Wound Therapy (Npwt)mentioning

confidence: 99%

Evidence update on prevention of surgical site infection

Leaper

Ousey

2015

Current Opinion in Infectious Diseases

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Address for correspondence: profdavidleaper@doctors.org.uk ABSTRACT Purpose of review: surgical site infection (SSI) is a common health care associated infection and complicates up to 10-20% of operations with considerable health care resources. Apart from the widely adopted use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and peri-operative glycaemic control to reduce SSIs this review has considered new research and systematic reviews, and whether their findings should be included in guidelines.Recent findings: The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and perioperative oxygen supplementation to reduce the risk of SSI is still in doubt. By contrast, the use of 2% chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic surgical dressings do show promise.Antimicrobial sutures in independent meta-analyses were found to reduce the risk of SSI after all classes of surgery (except dirty) whereas the use of wound guards, or diathermy skin incision (compared with scalpel incision), did not.Summary: The incidence of SSI after surgery is not falling. Based on this review of published trials and evidence-based systematic reviews some advances might be included into these care bundles. More research is needed together with improved compliance with care bundles.

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“…Grauhan et al [111] showed significant reduction of SSIs in obese patients (body mass index > 30 kg/m 2 ) with median sternotomy compared with patients treated with standard wound dressings. In general, retrospective studies and randomized controlled trials provided a substantial body of evidence that the use of this prophylactic wound dressing technique may reduce the incidence of wound infections [112][113][114] . …”

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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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Effect of surgical incision management on wound infections in a poststernotomy patient population

Cited by 63 publications

References 9 publications

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

Evidence update on prevention of surgical site infection

Deep sternal wound infection after cardiac surgery: Evidences and controversies

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