High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

“…Among them, we point out plastic reconstruction procedures using pectoralis muscle or omental flap [11,12]. More recently, the use of vacuum has been introduced as an intermediate stage between first-approach surgical debridement and definitive wound closure, but this approach is yet to be commercially spread in our field [17,20].…”

“…As an alternative, then, the use of PVPI was started for continuous mediastinal cavity wash since it is a fungicidal and bactericidal solution associated with low toxicity. The use of primary resuture with or without mediastinal irrigation offers the advantage of a procedure that produces a closed wound with stable sternum, but studies have reported high therapy failure associated with a high mortality rate [20].…”

“…Therapeutic modalities encompass two options: preconditioning of the wound, leaving the wound open for a better cleaning and mediastinal drainage with dressings, or using one of the several closure techniques available. Singlestage closure shows a recurrence rate between 5%-50% in comparison to two-stage closure whose rate ranges from 2%-30% [19,20], however the long term exposure of the mediastinum enhances the morbidity.The present study aims to compare inpatient mortality rate from surgical debridement followed by primary wound closure with that from surgical debridement with closure after preconditioning of the wound. …”

“…Among them, we point out plastic reconstruction procedures using pectoralis muscle or omental flap [11,12]. More recently, the use of vacuum has been introduced as an intermediate stage between first-approach surgical debridement and definitive wound closure, but this approach is yet to be commercially spread in our field [17,20].Based on our experience, preconditioning of the wound seemed to be a good therapeutic option in severe patients who develop postoperative mediastinitis. Despite the difficulty in maintaining a patient with the chest open, it seems an important technical improvement, which enables a definitive closure of the cavity in better technical and, mainly, clinical conditions.…”

Biopolymers as Wound Healing Materials: Challenges and New Strategies

“…It was concluded that papain immobilized in pectin can be used for the development of effective aerosol spray system for wound healing in the areas of enzymatic debridement of necrotic tissue and liquefaction of slough to remove dead or contaminated tissue in acute and chronic lesions, such as diabetic ulcers, pressure ulcers, varicose ulcers, and traumatic infected wounds, postoperative wounds, burns, carbuncles, and pilonidal cyst wounds (Jáuregui et al, 2009). Lyofoam, polyurethane foam, is normally hydrophobic; however, when applying heat and pressure, it becomes hydrophilic and, in this form, while providing blood and exudates absorption, it also prevents drying the wound surface completely (Johnson et al, 1998;Catarino et al, 2000;Fenn & Butler, 2001;Lehnert & Jhala, 2005).…”