Negative Pressure versus Conventional Sternal Wound Dressing in Coronary Surgery Using Bilateral Internal Mammary Artery Grafts

Ruggieri, Vito Giovanni; Olivier, Maud-Emmanuelle; Aludaat, Chaudi; Rosato, Stefano; Marticho, Paul; Saade, Yves Assad; Lefebvre, A.; Poncet, Anne; Rubin, Sylvain; Biancari, Fausto

doi:10.1532/hsf.2269

Cited by 14 publications

(36 citation statements)

References 11 publications

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“…In contrast to others, authors concluded that the routine use of iNPWT may not significantly reduce the risk of infections. 22 The largest study evaluating whether iNPWT can prevent DSWI was conducted in Germany by Grauhan et al 16 This manufacturer-sponsored trial included all patients with median sternotomy incision and compared those to a historical control group. Infection rates were 1.3 and 3.4%, respectively, a difference that was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Does Incisional Negative Pressure Wound Therapy Prevent Sternal Wound Infections?

Myllykangas

Halonen

Husso

et al. 2021

Thorac Cardiovasc Surg

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Background Incisional negative pressure wound therapy has been described as an effective method to prevent wound infections after open heart surgery in several publications. However, most studies have examined relatively small patient groups, only a few were randomized, and some have manufacturer-sponsorship. Most of the studies have utilized Prevena; there are only a few reports describing the PICO incisional negative pressure wound therapy system. Methods We conducted a prospective cohort study involving a propensity score-matched analysis to evaluate the effect of PICO incisional negative pressure wound therapy after coronary artery bypass grafting. A total of 180 high-risk patients with obesity or diabetes were included in the study group. The control group included 772 high-risk patients operated before the initiation of the study protocol. Results The rates of deep sternal wound infections in the PICO group and in the control group were 3.9 and 3.1%, respectively. The rates of superficial wound infections needing operative treatment were 3.1 and 0.8%, respectively. After propensity score matching with two groups of 174 patients, the incidence of both deep and superficial infections remained slightly elevated in the PICO group. None of the infections were due to technical difficulties or early interruption of the treatment. Conclusion It seems that incisional negative pressure wound therapy with PICO is not effective in preventing wound infections after coronary artery bypass grafting. The main difference in this study compared with previous reports is the relatively low incidence of infections in our control group.

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Section: Discussionmentioning

confidence: 99%

Does Incisional Negative Pressure Wound Therapy Prevent Sternal Wound Infections?

Myllykangas

Halonen

Husso

et al. 2021

Thorac Cardiovasc Surg

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“…One hundred and ninety-one studies were retrieved from a systematic literature search ( Supplementary Materials Figure S1 ). Ten studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] fulfilled the inclusion criteria. Their data are summarized in Table 2 and Supplementary Table S3 .…”

Section: Resultsmentioning

confidence: 99%

“…The results of the present pooled analysis could be summarized as follows: (1) there is evidence from recent studies of a widespread use of NPWT in adult cardiac surgery [ 11 , 13 , 16 ]; (2) the efficacy of NPWT in preventing post-sternotomy SWI has not been widely investigated; (3) NPWT may decrease the risk of SWI after adult cardiac surgery and its benefit may be more pronounced in preventing deep SWI; and (4) still, the evidence of a beneficial effect of NPWT in this patient population is based on studies with suboptimal quality.…”

Section: Discussionmentioning

confidence: 99%

“…This is confirmed by the results of most studies, with few exceptions [ 11 ]. A few recent studies [ 11 , 13 , 16 ] showed that there is a widespread use of this treatment, which suggest that clinicians are confident of a net benefit of NPWT, particularly in patients at highest risk of surgical site infection [ 11 , 13 ]. Since the risk of SWI is particularly increased after bilateral internal mammary artery grafting [ 21 ], a benefit with the preventative use of NPWT may be more evident in such high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

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Negative-Pressure Wound Therapy for Prevention of Sternal Wound Infection after Adult Cardiac Surgery: Systematic Review and Meta-Analysis

Biancari

Santoro²,

Provenzano³

et al. 2022

JCM

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The results of current studies are not conclusive on the efficacy of incisional negative-pressure wound therapy (NPWT) for the prevention of sternal wound infection (SWI) after adult cardiac surgery. A systematic review of the literature was performed through PubMed, Scopus and Google to identify studies which investigated the efficacy of NPWT to prevent SWI after adult cardiac surgery. Available data were pooled using RevMan and Meta-analyst with random effect models. Out of 191 studies retrieved from the literature, ten fulfilled the inclusion criteria and were included in this analysis. The quality of these studies was judged fair for three of them and poor for seven studies. Only one study was powered to address the efficacy of NPWT for the prevention of postoperative SWI. Pooled analysis of these studies showed that NPWT was associated with lower risk of any SWI (4.5% vs. 9.0%, RR 0.54, 95% CI 0.34–0.84, I2 48%), superficial SWI (3.8% vs. 4.4%, RR 0.63, 95% CI 0.29–1.36, I2 65%), and deep SWI (1.8% vs. 4.7%, RR 0.46, 95% CI 0.26–0.74, I2 0%), but such a difference was not statistically significant for superficial SWI. When only randomized and alternating allocated studies were included, NPWT was associated with a significantly lower risk of any SWI (3.3% vs. 16.5%, RR 0.22, 95% CI 0.08–0.62, I2 0%), superficial SWI (2.6% vs. 12.4%, RR 0.21, 95% CI 0.06–0.69, I2 0%), and deep SWI (1.2% vs. 4.8%, RR 0.17, 95% CI 0.03–0.95, I2 0%). This pooled analysis showed that NPWT may prevent postoperative SWI after adult cardiac surgery. NPWT is expected to be particularly useful in patients at risk for surgical site infection and may significantly reduce the burden of resources needed to treat such a complication. However, the methodology of the available studies was judged as poor for most of them. Further studies are needed to obtain conclusive results on the potential benefits of this preventative strategy.

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“…The authors stated that application of ciNPWT may reduce the risk of deep sternal wound infections following bilateral internal mammary artery harvest (level III) [63]. Furthermore, Ruggieri et al [65] published a prospective non-randomized study on patients undergoing isolated CABG using BIMA grafts, where ciNPWT was used in 161 patients and conventional sterile wound dressing was used in 266 patients. Propensity score matching was performed to allow statistical "pseudorandomisation", resulting in 128 matched pairs with similar characteristics.…”

Section: Cardiac Surgerymentioning

confidence: 99%

Closed-incision negative-pressure wound management in surgery—literature review and recommendations

et al. 2020

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Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

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Negative Pressure versus Conventional Sternal Wound Dressing in Coronary Surgery Using Bilateral Internal Mammary Artery Grafts

Cited by 14 publications

References 11 publications

Does Incisional Negative Pressure Wound Therapy Prevent Sternal Wound Infections?

Does Incisional Negative Pressure Wound Therapy Prevent Sternal Wound Infections?

Negative-Pressure Wound Therapy for Prevention of Sternal Wound Infection after Adult Cardiac Surgery: Systematic Review and Meta-Analysis

Closed-incision negative-pressure wound management in surgery—literature review and recommendations

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