Negative pressure wound therapy in the treatment of deep sternal wound infections – a critical appraisal

Myllykangas, Heidi-Mari; Berg, Leena; Husso, Annastina; Halonen, Jari

doi:10.1080/14017431.2021.1955963

Cited by 4 publications

(13 citation statements)

References 30 publications

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“…Among the 492 screened articles, a total of 4 studies were included in the present analysis. [7][8][9]13 A total of 438 patients were included in the pooled analysis. Overall, 229 patients had immediate flap reconstruction, and 209 patients were performed NPWT.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Three cohort studies involving 309 participants reported in-hospital mortality. 7,8,13 Meta-analysis with fixed-effects model indicated that compared with…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…Four cohort studies involving 438 participants reported LOS. [7][8][9]13 Outcomes of Tuo et al and E. Hamalainen et al reported as medians and interquartile ranges were transformed to means and standard deviations. 7,9,11,12 Meta-analysis with random-effects model indicated that compared with NPWT, immediate flap significantly reduced LOS (SMD À13.24, 95% CI À20.53 to À5.94, P = .0004) (Figure 4).…”

Section: Losmentioning

confidence: 99%

“…5,6 However, recent studies have shown that debridement combined with early flap reconstruction has better outcomes compared with NPWT. [7][8][9] Therefore, a meta-analysis was performed to evaluate the effects of immediate flap and NPWT on mortality and length of hospital stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

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Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Qiu

Sun

Huang

2023

International Wound Journal

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Deep sternal wound infection is a severe complication after cardiac surgery. We performed a meta‐analysis evaluating the impact of immediate flap and NPWT on mortality and length of hospital stay. The meta‐analysis was registered (CRD42022351755). A systematic literature search was conducted from inception to January, 2023, including PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov and EU Clinical Trials Register. The main outcome were in‐hospital mortality and late mortality. And additional outcomes were length of stay and ICU stay time. A total of 438 patients (Immediate flap: 229; NPWT: 209) from four studies were included in this study. Immediate flap was associated with lower in‐hospital mortality (OR 0.33, 95% CI 0.13‐0.81, P = .02) and length of stay (SMD −13.24, 95% CI −20.53 to −5.94, P = .0004). Moreover, pooled analysis demonstrated no significant difference was found in two groups in terms of late mortality (OR 0.64, 95% CI 0.35‐1.16, P = .14) and ICU stay time (SMD −1.65, 95% CI −4.13 to 0.83, P = .19). Immediate flap could reduce in‐hospital mortality and length of stay for patients with deep sternal wound infection. Flap transplantation as soon as possible may be advised.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Three cohort studies involving 309 participants reported in-hospital mortality. 7,8,13 Meta-analysis with fixed-effects model indicated that compared with…”

Section: In-hospital Mortalitymentioning

confidence: 99%

Section: Losmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Qiu

Sun

Huang

2023

International Wound Journal

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“…Yoshimoto and colleagues, 17 compared NPWT with standard therapy of wound debridement, dressings and delayed flap closure and concluded that patients undergoing NPWT had reduced hospital stay and achieved negative tissue cultures in reduced time. Myllykangas et al 18 reported that NPWT decreased the time between debridement and complete wound closure. Petzina et al 19 in their retrospective analysis of 118 patients, found that mortality with NPWT was 6% compared with 25% in patients who underwent debridement and dressings change without NPWT.…”

Section: Discussionmentioning

confidence: 99%

Management Outcome of Patients with Infected Sternotomy Wounds

Shabbir

Sarwar

Rashid

et al. 2023

PAFMJ

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Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Preoperatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional well being 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol.

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A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet‐rich plasma and negative pressure trauma therapy

Song

Chu

Zhang

et al. 2023

International Wound Journal

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Deep sternal wound infection (DSWI) is a relatively complex wound in wound reconstruction surgery. Because plastic surgeons deal with DSWI patients late. The primary healing (healing by first intention) after reconstruction of DSWI is restricted by many preoperative risk factors. The purpose of this study is to explore and analyse the risk factors of primary healing failure in patients with DSWI treated with platelet‐rich plasma (PRP) and negative pressure trauma therapy (NPWT). 115 DSWI patients treated with the PRP and NPWT (PRP + NPWT) modality were retrospectively (2013‐2021) analysed. They were divided into two groups according to primary healing results after the first PRP + NPWT treatment. Univariate and multivariate analyses were used to compare the data of the two groups to find out the risk factors and their optimal cut‐off values were identified by ROC analysis. The primary healing results, debridement history, wound size, sinus, osteomyelitis, renal function, bacterial culture, albumin (ALB), platelet (PLT) between the two groups were significantly different (P < 0.05). Binary logistic regression showed that osteomyelitis, sinus, ALB and PLT were the risk factors affecting primary healing outcomes (P < 0.05). ROC analysis showed that AUC for ALB in the non‐primary healing group was 0.743 (95% CI: 0.650‐0.836, P < 0.05) and its optimal cutoff value of 31 g/L was associated with primary healing failure with a sensitivity of 96.9% and specificity of 45.1%. AUC for PLT in the non‐primary healing group was 0.670 (95% CI: 0.571 ~ 0.770, P < 0.05) its optimal cutoff value of 293 × 109/L was associated with primary healing failure with a sensitivity of 72.5% and specificity of 56.3%. In the cases included in this study, the success rate of primary healing of DSWI treated with PRP + NPWT was not affected by the most common preoperative risk factors for wound non‐union. It is indirectly confirmed that PRP + NPWT is an ideal treatment. However, it should be noted that it will still be adversely affected by sinus osteomyelitis, ALB and PLT. The patients need to be carefully evaluated and corrected before reconstruction.

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Negative pressure wound therapy in the treatment of deep sternal wound infections – a critical appraisal

Cited by 4 publications

References 30 publications

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Management Outcome of Patients with Infected Sternotomy Wounds

A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet‐rich plasma and negative pressure trauma therapy

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