Effective Combination of Different Surgical Strategies for Deep Sternal Wound Infection and Mediastinitis

Tewarie, Lachmandath; Moza, Ajay; Khattab, Mohammad Amen; Autschbach, Rüdiger; Zayat, Rashad

doi:10.5761/atcs.oa.18-00115

Cited by 23 publications

(26 citation statements)

References 22 publications

(18 reference statements)

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“…Because of their high concentration in cancellous bones, fosfomycin and rifampicin proved to be effective in methicillin resistant staph aureus osteomyelitis [Yusef 2018]. Antifungal therapy can be added in the absence of clinical improvement on a broadspectrum antibiotic, even if no fungi are isolated [Abu-Omar 2017;Öztürk 2015;Tewarie 2019;Khanlari 2010]. In a recent study in our institution, the most common pathogen identified was coagulase negative staphylococcus epidermidis followed by S. aureus, pseudomonas and klebsiella [Elassal 2020].…”

Section: Diagnosismentioning

confidence: 99%

“…If the wound is clean and approximation is possible, direct sternal closure, either standard or reinforced, is the ideal solution. Tewarie and colleagues reported superior results, using bilateral pectoralis major muscle flap to the omental flap technique, in patients without sternal bone necrosis, with relatively low recurrence and mortality risks [Tewarie 2019]. Anger and colleagues described a new surgical technique to repair dehiscence using fasciocutaneous flaps from the pectoralis major fascia in 21 patients [Anger 2012].…”

Section: Managementmentioning

confidence: 99%

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Prevention, Classification and Management Review of Deep Sternal Wound Infection

Al‐Ebrahim

Al-Ebrahim

2020

HSF

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Sternal wound complications are significant problems in cardiac surgery and cause challenges to surgeons as they are associated with high mortality, morbidity, and a tremendous load on the hospital budget. Risk factors and preventive measures against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post cardiac surgery is important for specific categorization and management. Reviewing the literature, a variety of classifications was introduced to help understand the pathophysiology of these wounds and how best to manage them. Initial classifications were based on the postoperative period of the infectious process and risk factors. Recently, the anatomical description of sternal wound, including the depth and location, was shown to be more practical. There is a lack of evidence-based surgical consensus for the appropriate management strategy, including type of closure, choice of sternal coverage post sternectomy, whether primary, delayed and when to use reconstructive flaps.

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Section: Diagnosismentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Prevention, Classification and Management Review of Deep Sternal Wound Infection

Al‐Ebrahim

Al-Ebrahim

2020

HSF

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“…The pedicled omentum flap in comparison to PM or VRAM flaps is discussed controversially (Iacobucci et al, 1989; Milano et al, 1999; Tewarie et al, 2019). Kolbenschlag et al found wound healing disorders in 44% and partial flap necrosis in 4% as well as abdominal wall herniation occurring in 32% of cases (Kolbenschlag et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Comparison of pedicled versus free flaps for reconstruction of extensive deep sternal wound defects following cardiac surgery: A retrospective study

et al. 2021

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Background Myocutaneous pedicled flaps are the method of choice for sternal reconstruction after deep sternal wound infection (DSWI) following cardiac surgery. We set out to investigate whether free flaps provide a superior alternative for particularly extended sternal defects. Methods Between October 2008 and February 2020, 86 patients with DSWI underwent sternal reconstruction with myocutaneous flaps at our institution. Patients were retrospectively grouped into pedicled (A; n = 42) and free flaps (B, n = 44). The objective was to compare operative details, outcome variables, surgical as well as medical complication rates between both groups, retrospectively. Binary logistic regression analysis was applied to determine the effect of increasing defect size on flap necrosis. Results Rates of partial flap necrosis (>5% of the skin island) were significant higher in pedicled flaps (n = 14), when compared to free flaps (n = 4) (OR: 5.0; 33 vs. 9%; p = .008). Increasing defect size was a significant risk factor for the incidence of partial flap necrosis of pedicled flaps (p = .012), resulting in a significant higher rate of additional surgeries (p = .036). Binary regression model revealed that the relative likelihood of pedicled flap necrosis increased by 2.7% with every extra square‐centimeter of defect size. Conclusion To avoid an increased risk of partial flap necrosis, free flaps expand the limits of extensive sternal defect reconstruction with encouragingly low complication rates and proved to be a superior alternative to pedicled flaps in selected patients.

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“…Mortality in the group of patients with mediastinitis reaches from 47% to 50%. [6][7][8] Unfortunately, the treatment of infectious complications from a sternotomy wound is a complex and multicomponent task. So, for the surgical treatment of severe forms of sternomediastinitis and associated complications are of particular importance for medical and economic importance.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] In this case, fatal outcomes according to the literature range from 10% to 47% or more. [6][7][8] Another of the serious complications after operations performed by the transsternal approach is sternal dehiscence, which may require additional surgical intervention. Sternotomy wound healing is a long process.…”

Section: Introductionmentioning

confidence: 99%

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

2021

jcdr

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Background: In this report presented the results of surgical correction in septal defects associated with congenital heart defects from right-sided lateral thoracotomy. Carried out comparative assessment of perioperative indicators, such as the duration of the operation, the duration of artificial circulation, the duration of artificial ventilation of the lungs, the time of staying patients in the intensive care unit and postoperative hospital days in patients operated from right-sided lateral thoracotomy and standard longitudinal sternotomy.Methods: Were analyzed the results of surgical treatment of 150 patients with isolated heart septal defects, a combination of heart septal defects with pulmonary artery stenosis, with anomalies of the inflow of the pulmonary veins, with atrioventricular valve pathologies, as well as with aortic valve insufficiency. All patients were divided into two groups of equal number of patients. I -group (main group) of 75 patients operated on from a right-sided lateral thoracotomy. II -group (control group) 75 patients operated on from a median longitudinal sternotomy.Results: In the group of patients operated from lateral thoracotomy, there was a significant reduction in the total duration of operation, a shortening of the time of artificial lung ventilation, the length of stay of patients in the intensive care unit and reduction of postoperative hospital days. The duration of cardiopulmonary bypass among patients of both groups did not differ significantly, being 35.6 ± 3.45 minutes in the main group, and 39.48 ± 3.48 minutes in the control group, p = 0.43.All performed operations from right-sided thoracotomy access proceeded without technical difficulties, and the stages of elimination of existing defects were carried out in full according to the standard protocol. In no case was there a need for conversion. Patients were particularly satisfied with the achieved cosmetic effect. Conclusions:Based on the obtained results, the authors of the report came to the conclusion that right-sided thoracotomy can be used as an alternative surgical access to the standard sternotomy access in the surgery of septal defects and some congenital heart defects associated with it in conditions of artificial circulation. This access is less traumatic, better tolerated by patients and subsequently gives fewer complications.

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Effective Combination of Different Surgical Strategies for Deep Sternal Wound Infection and Mediastinitis

Cited by 23 publications

References 22 publications

Prevention, Classification and Management Review of Deep Sternal Wound Infection

Prevention, Classification and Management Review of Deep Sternal Wound Infection

Comparison of pedicled versus free flaps for reconstruction of extensive deep sternal wound defects following cardiac surgery: A retrospective study

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

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