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Open Access 01-12-2012 | Research article

Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment

Authors: Hayati Deniz, Gokhan Gokaslan, Yavuz Arslanoglu, Ozerdem Ozcaliskan, Gokalp Guzel, Alptekin Yasim, Hasim Ustunsoy

Published in: Journal of Cardiothoracic Surgery | Issue 1/2012

Abstract

Background

The aim of the present study is to compare negative pressure wound therapy versus conventional treatment outcomes at postoperative mediastinitis after cardiac surgery.

Methods

Between January 2000 and December 2011, after 9972 sternotomies, postoperative mediastinitis was diagnosed in 90 patients. The treatment modalities divided the patients into two groups: group 1 patients (n = 47) were initially treated with the negative pressure wound therapy and group 2 patients (n = 43) were underwent conventional treatment protocols. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student’s test and Fisher’s exact test.

Results

The 90-days mortality was found significantly lower in the negative pressure wound group than in the conventionally treated group. Overall survival was significantly better in the negative pressure wound group than in the conventionally treated group.

Conclusion

Negative pressure wound therapy is safe and reliable option in mediastinitis after cardiac surgery, with excellent survival and low failure rate when compared with conventional treatments.

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Tang ATM, Ohri SK, Haw MP: Novel application of vacuum assisted closure tecnique to the treatment of sternotomy wound infection. Eur J Cardio-Thorac Surg. 2000, 17: 482-484. 10.1016/S1010-7940(00)00349-3.CrossRef

Raudat CW, Pagel J, Woodhall D, Wojtanowski M, Van Bergen R: Early interventin and aggresive management of infected median sternotomy incision: a reviwe of 2242 open-heart procedures. Am Surg. 1997, 63: 238-241.PubMed

Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH: Mediastinitis after coronary artery bypass graft surgery. Circulation. 1995, 92: 2245-2251. 10.1161/01.CIR.92.8.2245.CrossRefPubMed

Lu JCY, Grayson AD, Jha P, Srinivasan AK, Fabri BM: Risk factors for sternal wound infection and mid-term survival follewing coronary artery bypass surgery. Eur J Cardiovasc Surg. 2003, 23: 943-949. 10.1016/S1010-7940(03)00137-4.CrossRef

Gardlung B, Bitkover CY, Vaage J: Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiovasc Surg. 2002, 21: 825-830. 10.1016/S1010-7940(02)00084-2.CrossRef

Argenta LC, Morykwas MJ: Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997, 38: 563-576. 10.1097/00000637-199706000-00002.CrossRefPubMed

Obdeijn MC, de Lange MY, Lichtendahl DH, de Boer WJ: Vacuum-assisted closure in treatment of poststernotomy mediastinitis. Ann Thorac Surg. 1999, 68: 2358-2360. 10.1016/S0003-4975(99)01159-5.CrossRefPubMed

Luckraz H, Murphy F, Bryant S, Charman S, Ritchie A: Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. J Thorac Cardiovasc Surg. 2003, 125: 301-305. 10.1067/mtc.2003.74.CrossRefPubMed

Sjögren J, Gustafsson R, Dobre M, Koul B, Ingemansson R, Algotsson L: Vacuum-assisted closure therapy in mediastinitis after heart transplantation. J Heart Lung Transplant. 2004, 23: 506-507. 10.1016/S1053-2498(03)00224-9.CrossRefPubMed

10.

Garner J, Jarvis WR, Emori GT, Horan TC, Huges J: CDC definitions for nosocomial infections 1988. Am J Infect Control. 1988, 16: 128-140. 10.1016/0196-6553(88)90053-3.CrossRefPubMed

11.

El Oakley R, Wright J: Postoperative mediastinitis: clasification and management. Ann Thorac Surg. 1996, 61: 1030-1036. 10.1016/0003-4975(95)01035-1.CrossRefPubMed

12.

Wettstein R, Erni D, Berdat P, Rothenfluh D, Banic A: Radical sternotomy and primary musculocutaneous flap reconstruction to control sternal osteitis. J Thorac Cardiovasc Surg. 2002, 123: 1185-1190. 10.1067/mtc.2002.121304.CrossRefPubMed

13.

Gustafsson RI, Sjogren J, Ingemansson R: Deep sternal wound infection: a sternal sparing technique with vacuum-assisted closure therapy. Ann Thorac Surg. 2003, 76: 2048-2053. 10.1016/S0003-4975(03)01337-7.CrossRefPubMed

14.

Nashef SAM, Roques F, Michel P: European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiovasc Surg. 1999, 16: 9-13. 10.1016/S1010-7940(99)00134-7.CrossRef

15.

De Feo M, Renzulli A, Isomeno G: Variables predicting adverse outcome in patients with deep sternal wound infection. Ann Thorac Surg. 2001, 71: 324-331. 10.1016/S0003-4975(00)02137-8.CrossRefPubMed

16.

Julian OC, Lopez-Belio M, Dye WS, Javid H, Grove WJ: Appraisal of progress in surgical therapy. Surgery. 1957, 42: 753-761.PubMed

17.

Loop FD, Lytle BW, Cosgrove DM: Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann Thorac Surg. 1990, 49: 179-187. 10.1016/0003-4975(90)90136-T.CrossRefPubMed

18.

Sarr MG, Gott VL, Townsend TR: Mediastinal infections after sternotomy. Ann Thorac Surg. 1984, 38: 415-423. 10.1016/S0003-4975(10)62300-4.CrossRefPubMed

19.

Bryant LR, Spencer FC, Trinkle TR: Treatment of median sternotomy infection by mediastinal irrigation with an antibiotic solution. Ann Thorac Surg. 1969, 169: 914-920.

20.

Rand RP, Cochran RP, Aziz S: Prospective trial of catheter irrigation and muscle flaps for sternal wound infection. Ann Thorac Surg. 1998, 65: 1046-1049. 10.1016/S0003-4975(98)00087-3.CrossRefPubMed

21.

Grossi EA, Culliford AT, Krieger KH: A survey of 77 major infectious complications of median sternotomy: arewiev of 7949 consecutive operative procedures. Ann Thorac Surg. 1985, 40: 214-223. 10.1016/S0003-4975(10)60030-6.CrossRefPubMed

22.

Jurkiewicz MJ, Bostwick J, Hester TR, Bishop JB, Craver J: Infected median sternotomy wound; successful treatment by muscle flaps. Ann Surg. 1980, 191: 738-744. 10.1097/00000658-198006000-00012.CrossRefPubMedPubMedCentral

23.

Jones G, Jurkiewicz MJ, Bostwick J: Management of the infected median sternotomy wound with muscle flaps: the Emory 20 year experience. Ann Surg. 1997, 225: 766-776. 10.1097/00000658-199706000-00014.CrossRefPubMedPubMedCentral

24.

Lee AB, Schimert G, Shatkin S: Total excision of the sternum and thtacic pedicle transposition of the greater omentum. Surgery. 1976, 80: 433-436.PubMed

25.

Milano CA, Georgiade G, Mulbaier LH: Comparison of omental and pectoral flaps for poststernotomy mediastinitis. Ann Thorac Surg. 1999, 67: 377-381. 10.1016/S0003-4975(99)00022-3.CrossRefPubMed

26.

Morykwas MJ, Argenta LC, Shelton-Brown EL, McGuirt W: Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997, 38: 553-562. 10.1097/00000637-199706000-00001.CrossRefPubMed

27.

Douville EC, Asaph JW, Dworkin RJ: Sternal preservation: beter way to treat most sternal wound compications after cardiac surgery. Ann Thorac Surg. 2004, 78: 1659-1664. 10.1016/j.athoracsur.2004.04.082.CrossRefPubMed

28.

Catarino PA, Chamberlain MH, Wright NC: High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis. Ann Thorac Surg. 2000, 70: 1891-1895. 10.1016/S0003-4975(00)02173-1.CrossRefPubMed

29.

Braxton JH, Marrin CAS, McGrath PD: Mediastinitis and long-term survival after coronary bypass graft surgery. Ann Thorac Surg. 2000, 70: 2004-2007. 10.1016/S0003-4975(00)01814-2.CrossRefPubMed

30.

Doss M, Martens S, Wood JP, Wolff JD, Basier C, Moritz A: Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiovasc Surg. 2002, 22: 934-938. 10.1016/S1010-7940(02)00594-8.CrossRef

31.

Simek M, Hajek R, Fluger I, Molitor M, Grulichova J, Langova K, Tobbia P, Nemec P, Zalesak B, Lonsky V: Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery. J Cardiovasc Surg (Torino). 2012, 53 (1): 113-120.

32.

Assmann A, Boeken U, Feindt P, Schurr P, Akhyari P, Lichtenberg A: Vacuum-assisted wound closure is superior to primary rewiring in patients with deep sternal wound infection. Thorac Cardiovasc Surg. 2011, 59 (1): 25-29. 10.1055/s-0030-1250598. Epub 2011 Jan 17CrossRefPubMed

Title: Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment
Authors: Hayati Deniz
Gokhan Gokaslan
Yavuz Arslanoglu
Ozerdem Ozcaliskan
Gokalp Guzel
Alptekin Yasim
Hasim Ustunsoy
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2012
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-7-67

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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