Risk factors of infected sternal wounds versus sterile wound dehiscence

Fu, Rose H.; Weinstein, Andrew L.; Chang, Michelle M.; Argenziano, Michael; Ascherman, Jeffrey A.; Rohde, Christine

doi:10.1016/j.jss.2015.07.045

Cited by 41 publications

(43 citation statements)

References 27 publications

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“…Critically poor pulmonery function is also a significant factor preventing us from putting the patient general anesthesic situation which is neccessery for transverse plate fixation or zipfix system instead of steel wires. 4 We had tightened the loosed wires and done limited debridement under local anesthesia.…”

Section: A Amentioning

confidence: 99%

Sternal Steel Wire Induced Persistant Intermittan Mediastinal Wound Drainage After CABG

Ata¹,

Boylu²

2018

Turkiye Klinikleri J Case Rep

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tainless steel wire suture is a standard approach to approximate sternum for median sternotomy patients because of it's safe, fast and inexpensive features since first discribed by Milton in 1897.8 Sternal wound infection, sternal dehiscence and bony nonunion are among the complications mostly reported. Few cases were reported about persistent sternal pain because of hypersensitivity which required removal of sternal wires. 2,3Compared with other published cases, this clinical case report is characterised intermittant persistant wound drainage from multiple small holes on the sternotomy incision without pain, repeated wound cultures were negative and no laboratory evidence was found indicating mediastinitis.Intermittan Mediastinal Wound Drainage after CABG: Case Report A AB BS ST TR RA AC CT T Delayed mediastinal wound drainage due to hypersensitivity to stainless steel sternal wire is very rare conditions in post sternotomy patients. In literature, although some cases reported about treatment by removing the sternal wires because of persistant chest pain due to hypersensitivity, it is rarely reported about conditions that persistant wound drainage from sternal incision due to reactions to strnal wires. We present such a complicated case about these who developed tissue overgranulation and sternal dehiscence and persistent intermittant sternal wound drainage for about twelve months after emergency CABG. Repeated wound cultures were negative and no laboratory evidence was founded indicating mediastinitis. We believe there are no previously published papers in literature describing and managing condition like this.K Ke ey yw wo or rd ds s: : Coronery artery bypass; drainage; stainless steel; mediastinitis; surgical wound dehiscence Ö ÖZ ZE ET T Sternotomi sonrası sternum tellerine aşırı duyarlılık nedeni ile mediastende gelişen uzamış akıntı çok nadir görülen bir durumdur. Sternum tellerine karşı aşırı duyarlılık nedeni ile göğüs ağrısı geçmeyen hastalarda sternum tellerinin çıkartılarak tedavi edildiğine ait bazı literatür bulunmasına karşın sternum tellerine karşı reaksiyon nedeni ile sternum insizyon yeri üzerinde geç-meyen akıntısı olan hastalar çok nadır rapor edilmiştir. Acil koroner arter bypass ameliyatı sonrası sternum telleri üzerinde aşırı granülasyon dokusu oluşan ve dehiscence gelişen bu komplike vakada mediastinit bulgusu olmaksızın yaklaşık 12 ay boyunca insizyon üzerinden akıntısı devam etmiştir. Benzer olguların tanımı ve tedavi yöntemi ile ilgili daha önce literatürde yayınlanmış rapor olmadığı kanısındayız.A An na ah ht ta ar r K Ke el li im me el le er r: : Koroner arter bypass; akıntı; paslanmaz çelik; mediastinit; cerrahi yara açılması A Ar rt ti ic cl le e i in n P Pr re es ss s

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Section: A Amentioning

confidence: 99%

Sternal Steel Wire Induced Persistant Intermittan Mediastinal Wound Drainage After CABG

Ata¹,

Boylu²

2018

Turkiye Klinikleri J Case Rep

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“…Obesity may act as a positive predictor of sternal wound infection and dehiscence due to increased weight of soft tissue adding mechanical stress to chest closure. This can prevent union of the sternal halves secondary to increased motion, thus disrupting epithelialization and angiogenesis of soft tissues (9). In patients undergoing median sternotomy followed by wire cerclage closure, obesity (BMI >30 kg/m 2 ) is a known preoperative risk factor for sternal dehiscence and sternal wound infection, most notably, mediastinitis (9,14-16).…”

Section: Management Of Sternotomy and Closurementioning

confidence: 99%

“…Post-sternotomy mediastinitis and deep sternal wound infection are devastating complications of cardiac surgery with studies reporting incidence of 0.7-11.1% following standard sternotomy closure (7). Several studies have reported that BMI >30 kg/m 2 increases the odds of developing sternal wound infection; in some studies, it has been demonstrated as the only preoperative risk factor for Surgical Technique on Cardiac Surgery Operative techniques for improving surgical exposure in basic cardiac surgery deep sternal wound infection following coronary artery bypass grafting (CABG) (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Operative techniques for improving surgical exposure in basic cardiac surgery

et al. 2018

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Operative exposure is key to ensuring surgical efficiency and patient safety in cardiac surgery. As the population ages and the prevalence of obesity increases, cardiac surgeons will be challenged to consider obese patient physiology and body habitus, surgical exposure and sternotomy closure techniques, and postoperative medical management to ensure optimal outcomes. In this article, we describe techniques to improve operative exposure in both obese and non-obese patients undergoing basic cardiac surgery and highlight the roles of surgical team members to ensure patient safety and provide optimal anesthetic management. We describe pre-operative techniques regarding incision-site marking and alternative positioning techniques on the operating table to improve visualization and decrease risk of upper extremity injury. We summarized the roles of surgical team members regarding patient positioning, especially in those that are obese, and the challenges associated for anesthesia staff pre- and intraoperatively. Procedural techniques regarding sternotomy management and closure, cannulation, internal mammary harvest, and mitral valve exposure are discussed. Cardiac surgical teams must consider the risks associated with the obese patient population undergoing cardiac surgery procedures and employ techniques pre-, intra-, and postoperatively in a multidisciplinary fashion. Safe and efficacious techniques are paramount to optimal patient outcomes.

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“…These factors include older age, obesity, diabetes, tobacco smoking, and vascular diseases. 2,12 Wound infections, which occur following roughly 0.3% of surgeries and can also complicate non-surgical injuries, also delay wound healing. 2,13,14 Wounds can reopen following a surgical closure, a process called dehiscence, which often occurs due to an infection of the wound.…”

Section: Overview Of Wound Healingmentioning

confidence: 99%

The contribution of interleukin-2 to effective wound healing

Doersch

DelloStritto

Newell‐Rogers

2016

Exp Biol Med (Maywood)

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Ineffective skin wound healing is a significant source of morbidity and mortality. Roughly 6.5 million Americans experience chronically open wounds and the cost of treating these wounds numbers in the billions of dollars annually. In contrast, robust wound healing can lead to the development of either hypertrophic scarring or keloidosis, both of which can cause discomfort and can be cosmetically undesirable. Appropriate wound healing requires the interplay of a variety of factors, including the skin, the local microenvironment, the immune system, and the external environment. When these interactions are perturbed, wounds can be a nidus for infection, which can cause them to remain open an extended period of time, or can scar excessively. Interleukin-2, a cytokine that directs T-cell expansion and phenotypic development, appears to play an important role in wound healing. The beststudied role for Interleukin-2 is in influencing T-cell development. However, other cell types, including fibroblasts, the skin cells responsible for closing wounds, express the Interleukin-2 receptor, and therefore may respond to Interleukin-2. Studies have shown that treatment with Interleukin-2 can improve the strength of healed skin, which implicates Interleukin-2 in the wound healing process. Furthermore, diseases that involve impaired wound healing, such as diabetes and systemic lupus erythematosus, have been linked to deficiencies in Interleukin-2 or defects Interleukin-2-receptor signaling. The focus of this review is to summarize the current understanding of the role of Interleukin-2 in wound healing, to highlight diseases in which Interleukin-2 and its receptor may contribute to impaired wound healing, and to assess Interleukin-2-modulating approaches as potential therapies to improve wound healing.

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Risk factors of infected sternal wounds versus sterile wound dehiscence

Cited by 41 publications

References 27 publications

Sternal Steel Wire Induced Persistant Intermittan Mediastinal Wound Drainage After CABG

Sternal Steel Wire Induced Persistant Intermittan Mediastinal Wound Drainage After CABG

Operative techniques for improving surgical exposure in basic cardiac surgery

The contribution of interleukin-2 to effective wound healing

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