2011
DOI: 10.1055/s-0030-1250373 View full text |Buy / Rent full text
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Abstract: TGO remains a good treatment option for DSWI type IV. Microbial findings determine the clinical course; nevertheless in-hospital mortality remains low for both MRSA and MRSE infection.

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“…Concerns still remain about the need for obtaining negative cultures at the time of closure. Two recent studies found that the presence of positive tissue cultures did not affect the rate of recurrent infections [80,81] . An important step forward in the treatment of DSWI occurred with the introduction of continuous irrigation using closed chest catheter following revision.…”
Section: Managementmentioning
“…Usually, the use of omentum is considered in the case of complex wounds or when the defect is extremely wide with significant sternal loss. Specifically, a definite preference has been expressed for the use of omentum when the primary causative pathogen is particularly resistant, such as MRSA [80,89] and Candida [90] or when the patients suffering from diabetes mellitus [91] . However, complications occurred in up to 18% of patients treated with this approach [16,92] .…”
Section: Antimicrobial Prophylaxismentioning
“…(class IIb, level B2) Gustafsson [ 48 ] and others [ 49 ] have been guided by plasma C-reactive protein levels (<30–70 mg/L), while others have suggested that three consecutive negative wound and tissue cultures are more reliable predictors [ 45 ] (all class IIb, level B2). The necessity for obtaining negative cultures has been questioned by two very recent studies [ 50 ],[ 51 ], which found that the presence of positive tissue cultures at the time of closure does not influence the rate of readmissions for recurrent infection.…”
Section: Reviewmentioning
“…A clear preference has been expressed for the use of omentum (instead of muscle) in cases where the primary causative organism is particularly resistant, such as MRSA [ 50 ],[ 77 ]-[ 80 ] (class IIb, level B2) or Candida [ 31 ],[ 81 ] (class IIb, level C & class IIa, level B1, resp.) or where the patient suffers from diabetes mellitus [ 82 ] (class IIb, level B1).…”
Section: Reviewmentioning
“…1,2 They cause a noteworthy excess of costs due to complex and time-consuming treatment modalities. 3,4 Several factors predisposing to DSWI-among them age, diabetes mellitus, chronic obstructive lung disease, obesity, congestive heart failure, use of double internal mammary artery (IMA)-have been identified in several studies. [5][6][7] As a remarkable shift in the surgical cohort in recent years toward an older and sicker population has been occurred, 8 cardiac surgery to date is confronted with a rising number of patients with one or multiple risk factors for DSWI.…”
Section: Introductionmentioning