Vacuum Assistance Therapy As Compared to Early Reconstructive Treatment in Deep Sternal Wound Infection

Overview

Journal Scand J Surg

Specialty General Surgery

Date 2020 Dec 17

PMID 33327852

Citations 7

Authors

E Hamalainen

J Laurikka

H Huhtala

O Jarvinen

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Deep sternal wound infection is a major concern after cardiac surgery. This study describes the incidence of postoperative deep sternal wound infections after cardiac surgery and compares two available treatment modalities.

Materials And Methods: In Tampere University Hospital, 7973 open heart operations were performed between 2007 and 2016. Patients treated for a postoperative deep sternal wound infection were categorized in two groups based on treatment: revision surgery with early reconstruction (revision group; 74 patients) or vacuum-assisted closure treatment (VAC group; 55 patients). The end points in comparisons were overall mortality and hospitalization time.

Results: A total of 129 patients (1.6%) developed a postoperative deep sternal wound infection. The 30-day mortality rates were 8.1% and 3.6%, the 90-day mortality rates were 15.5% and 18.2%, and the 1-year mortality rates were 17.6% and 23.6% for the revision and VAC group, respectively. There was no statistically significant difference in mortality rates. The hospital stay was 18 days in the revision group and 38 days in the VAC group (p < 0.001). The secondary intensive care unit stay was longer in the VAC group (median 1 vs 4, p = 0.011). The most common pathogens isolated in the first reoperation were coagulase-negative staphylococci (33.8% and 41.8%, respectively; p = 0.366), and positive candida findings were more common in the VAC group (4.1% vs 37.0 %, p < 0.001).

Conclusion: Vacuum-assisted closure treatment induces an inferior outcome in terms of fungal infections, treatment times, and the number of reoperations.

Citing Articles

Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis.

Liu Y, Lin S, Peng C, Huang R, Lin C, Hsu C Int J Surg. 2025; 110(12):8107-8125.

PMID: 39806749 PMC: 11634157. DOI: 10.1097/JS9.0000000000002138.

Sternal Wound Reconstruction Following Deep Sternal Wound Infection: Past, Present and Future: A Literature Review.

Khashkhusha A, Butt S, Abdelghaffar M, Wang W, Rajananthanan A, Roy S J Cardiovasc Dev Dis. 2024; 11(11).

PMID: 39590204 PMC: 11595137. DOI: 10.3390/jcdd11110361.

The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections.

Bota O, Taqatqeh F, Bonke F, Mulhausen M, Matschke K, Dragu A J Cardiothorac Surg. 2024; 19(1):25.

PMID: 38268012 PMC: 10809468. DOI: 10.1186/s13019-024-02491-7.

The role of negative pressure wound therapy with instillation and dwell time in the treatment of deep sternal wound infections-A retrospective cohort study.

Bota O, Taqatqeh F, Bonke F, Nowotny J, Matschke K, Bienger K Health Sci Rep. 2023; 6(7):e1430.

PMID: 37465238 PMC: 10350553. DOI: 10.1002/hsr2.1430.

Review on risk factors, classification, and treatment of sternal wound infection.

Song Y, Chu W, Sun J, Liu X, Zhu H, Yu H J Cardiothorac Surg. 2023; 18(1):184.

PMID: 37208736 PMC: 10199640. DOI: 10.1186/s13019-023-02228-y.

References

Swenne C, Skytt B, Lindholm C, Carlsson M . Patients' experiences of mediastinitis after coronary artery bypass graft procedure. Scand Cardiovasc J. 2007; 41(4):255-64. DOI: 10.1080/14017430701283856. View

Merrill W, Akhter S, Wolf R, Schneeberger E, Flege Jr J . Simplified treatment of postoperative mediastinitis. Ann Thorac Surg. 2004; 78(2):608-12. DOI: 10.1016/j.athoracsur.2004.02.089. View

Baillot R, Cloutier D, Montalin L, Cote L, Lellouche F, Houde C . Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies. Eur J Cardiothorac Surg. 2009; 37(4):880-7. DOI: 10.1016/j.ejcts.2009.09.023. View

Finkelstein R, Rabino G, Mashiah T, Bar-El Y, Adler Z, Kertzman V . Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control. 2005; 33(8):450-4. DOI: 10.1016/j.ajic.2005.07.002. View

Eklund A, Lyytikainen O, Klemets P, Huotari K, Anttila V, Werkkala K . Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg. 2006; 82(5):1784-9. DOI: 10.1016/j.athoracsur.2006.05.097. View

Risnes I, Abdelnoor M, Veel T, Svennevig J, Lundblad R, Rynning S . Mediastinitis after coronary artery bypass grafting: the effect of vacuum-assisted closure versus traditional closed drainage on survival and re-infection rate. Int Wound J. 2012; 11(2):177-82. PMC: 7950556. DOI: 10.1111/j.1742-481X.2012.01060.x. View

Sjogren J, Malmsjo M, Gustafsson R, Ingemansson R . Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg. 2006; 30(6):898-905. DOI: 10.1016/j.ejcts.2006.09.020. View

Deniz H, Gokaslan G, Arslanoglu Y, Ozcaliskan O, Guzel G, Yasim A . Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg. 2012; 7:67. PMC: 3432617. DOI: 10.1186/1749-8090-7-67. View

Segers P, de Jong A, Kloek J, de Mol B . Poststernotomy mediastinitis: comparison of two treatment modalities. Interact Cardiovasc Thorac Surg. 2007; 4(6):555-60. DOI: 10.1510/icvts.2005.112714. View

10.

Speir A, Kasirajan V, Barnett S, Fonner Jr E . Additive costs of postoperative complications for isolated coronary artery bypass grafting patients in Virginia. Ann Thorac Surg. 2009; 88(1):40-5. DOI: 10.1016/j.athoracsur.2009.03.076. View

11.

Tocco M, Costantino A, Ballardini M, DAndrea C, Masala M, Merico E . Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection. Eur J Cardiothorac Surg. 2009; 35(5):833-8. DOI: 10.1016/j.ejcts.2008.12.036. View

12.

Wouters R, Wellens F, Vanermen H, De Geest R, Degrieck I, De Meerleer F . Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J. 1994; 21(3):183-8. PMC: 325162. View

13.

Lola I, Levidiotou S, Petrou A, Arnaoutoglou H, Apostolakis E, Papadopoulos G . Are there independent predisposing factors for postoperative infections following open heart surgery?. J Cardiothorac Surg. 2011; 6:151. PMC: 3223138. DOI: 10.1186/1749-8090-6-151. View

14.

Indja B, Seco M, Seamark R, Kaplan J, Bannon P, Grieve S . Neurocognitive and Psychiatric Issues Post Cardiac Surgery. Heart Lung Circ. 2017; 26(8):779-785. DOI: 10.1016/j.hlc.2016.12.010. View