Post-sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement†

Ikeno, Yuki; Sakakibara, Shunsuke; Yokawa, Koki; Kitani, Keitaro; Nakai, Hidekazu; Yamanaka, Katsuhiro; Inoue, Takeshi; Tanaka, Hiroshi; Terashi, Hiroto; Okita, Yutaka

doi:10.1093/ejcts/ezy389

Cited by 11 publications

(16 citation statements)

References 26 publications

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“…NPWTci is a suitable management method for mediastinal wounds with prosthetic graft exposure. Ikeno et al reported favorable outcomes of NPWTci in 18 patients with PSM and prosthetic graft infection [3]. NPWTci aims to control wound infection and minimize the chance of prosthetic graft infections recurring when a negative bacterial culture is obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Pulsed wound lavage with 10 L of normal saline using PulsaVAC® (Zimmer Biomet Holdings, Inc., USA) was performed under general anesthesia. The wound was managed by negative pressure wound therapy with continuous irrigation (NPWTci) [3], which consisted of continuous normal saline irrigation at 100 mL/hour via three tubes and application of 75 mmHg of negative pressure via polyurethane foam. The foam dressing change and wound lavage using PulsaVAC® were performed twice a week in the operating room.…”

Section: Case Presentationmentioning

confidence: 99%

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Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection

Kitano¹,

Matsuo²,

Sakakibara³

et al. 2021

Cureus

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Extra-anatomical bypass grafting is a surgical method used to remove an infected aortic graft and promote revascularization with a new graft in the non-infected area. Here, we report a case of intractable poststernotomy mediastinitis (PSM) with aortic graft infection which was treated with extra-anatomical bypass grafting. A 56-year-old woman with a history of multiple aortic dissection and prosthetic graft replacement in the thoracoabdominal area developed PSM with aortic arch graft infection. Bacterial culture of the exposed prosthetic graft tissue yielded multidrug-resistant Pseudomonas aeruginosa. Meticulous debridement of the wound and management by negative pressure wound therapy with continuous irrigation was performed. However, the infection of the prosthetic graft could not be controlled. Extra-anatomical bypass was performed between the left common carotid artery and right subclavian artery via the right common carotid artery. Then, the infected graft was removed. After the resolution of infection, the mediastinal wound was reconstructed with a pedicled latissimus dorsi myocutaneous flap, which was harvested from the right dorsum. No recurrence of infection occurred in the nine-month follow-up period. Debridement and removal of exposed artificial graft are considered the gold standard for treating wound infection. In situ replacement of infected aortic grafts carries a risk of re-infection due to residual bacterial contamination of the periprosthetic tissue. Extra-anatomical bypass would be a useful option for reducing the risk of re-infection in patients with intractable PSM and prosthetic aortic graft infection. Further studies are warranted to evaluate the risks and benefits of this operative method.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection

Kitano¹,

Matsuo²,

Sakakibara³

et al. 2021

Cureus

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“…10,11 A previous study reported that NPWT with continuous irrigation improved hospital mortality from 50% to 16.7% in patients with DSWI with prosthetic graft infection. 10 Continuous or intermittent irrigation and drainage contributes to the control of bacterial infections by washing the purulent and necrotic tissues, a strategy termed hydrodebridement. Takagi et al 15 proposed a combination therapy of hydrodebridement with pulsed lavage and NPWT for patients with DSWI with prosthetic graft infection.…”

Section: Commentarymentioning

confidence: 99%

“…8,9 Various salvage treatments for DSWI or DSWI with prosthetic graft infection have been reported. 3,4,[10][11][12][13] The surgical debridement of infected tissues and removal of purulent tissue must be conducted immediately when DSWI with prosthetic graft infection is diagnosed to reduce the bacterial population, control the infection, and ameliorate the patient's condition. NPWT is a standard treatment for patients with DSWI after debridement as it stabilizes the thoracic cage and controls the bacterial infection.…”

Section: Commentarymentioning

confidence: 99%

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

Morisaki

2022

Journal of Cardiac Surgery

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Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydrodebridement with pulsed lavage and negative pressure wound therapies.

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“…Negative pressure wound therapy with continuous irrigation (NPWTci) was performed after debridement operation 10) . Continuous irrigation with normal saline at a rate of 100 mL/h and negative pressure of 75 mmHg was applied to the mediastinal wound via polyurethane foam.…”

Section: Introductionmentioning

confidence: 99%

Late-onset Post-Sternotomy Mediastinitis with Hematogenous Metastasis of Infection in Hemodialysis Patient

Kitano

Sakakibara

Osaki

et al. 2021

International Journal of Surgical Wound Care

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Post-sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement†

Cited by 11 publications

References 26 publications

Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection

Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

Late-onset Post-Sternotomy Mediastinitis with Hematogenous Metastasis of Infection in Hemodialysis Patient

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