Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing

Abstract

One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram‐negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.

Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure

“…Gentamicin is the most commonly used antibiotic to prevent possible infections after sternal surgery. In the literature, collagen–Gentamicin sponges have been used to prevent local infection of the sternal region after being covered with steel wires. − For this reason, 2.5% Gentamicin was doped to the adhesive formulation for local release. The results are given as cumulative Gentamicin release in Figure B.…”

“…Absorption of Gentamicin into the adhesive may assist in localized delivery at a higher concentration and may reduce systemic toxicity. In the literature, Gentamicin-collagen sponges are used for local antibiotic effect, and it has been reported that these sponges have no adverse effects . Therefore, Gentamicin was absorbed into the adhesive formulation to reduce systemic toxicity.…”

“…In the literature, Gentamicin-collagen sponges are used for local antibiotic effect, and it has been reported that these sponges have no adverse effects. 64 Therefore, Gentamicin was absorbed into the adhesive formulation to reduce systemic toxicity. The agar disc diffusion method was used to determine the antimicrobial activity of the adhesive.…”

Multifunctional Bioinspired Bredigite-Modified Adhesive for Bone Fracture Healing

“…Full median sternotomy is the favored surgical strategy to access the heart, large vessels, esophagus, trachea, and other structures in thoracic surgery . The established fixation strategies (i.e., the use of wire cerclage, sternal screws, and stainless-steel plates) are facing numerous issues, including breaking via osteoporotic bone to chest, stress shielding, the necessity for secondary surgery, an additional requirement for a hemostatic agent, and the probability of infection triggered by transcutaneous implants . For effective bleeding control, osteogenesis, and infection, various kinds of biomaterials consisting of cement, bone waxes, gels, and adhesives have been developed.…”

“…1 The established fixation strategies (i.e., the use of wire cerclage, sternal screws, and stainless-steel plates) are facing numerous issues, including breaking via osteoporotic bone to chest, stress shielding, the necessity for secondary surgery, an additional requirement for a hemostatic agent, and the probability of infection triggered by transcutaneous implants. 2 For effective bleeding control, osteogenesis, and infection, various kinds of biomaterials consisting of cement, bone waxes, gels, and adhesives have been developed. Between them, tissue adhesives have been introduced as effective strategies for sternal closure, improving sternal healing, and postoperative recovery after conventional cardiac surgery.…”