From open packing to negative wound pressure therapy: A critical overview of deep sternal wound infection treatment strategies after cardiac surgery.

Martin Simek,Petr Nemec,Roman Hajek,Adam Chudoba,Martin Molitor,Patrick Tobbia

doi:10.5507/bp.2018.053

Martin Simek, Petr Nemec + Show 4 more

Open Access

https://doi.org/10.5507/bp.2018.053

Copy DOI

Abstract

Deep sternal wound infection is a challenging aspect of modern cardiac surgery. The considerable mortality rate, devastating morbidity and, negative impact on long-term survival has driven cardiac and plastic surgeons to seek a more advantageous treatment solution. This review summarizes progress in the field of deep sternal wound infection treatment after cardiac surgery. Emphasis is placed on outcomes analysis of contemporary treatment strategy based on negative pressure wound therapy followed by sternotomy wound reconstruction, and its comparison with conventional treatment modalities used afore. Furthermore, complications and drawbacks of treatment strategies are critically evaluated to outline current options for successfully managing this life-threatening complication following cardiac surgery.

Highlights

Deep sternal wound infection (DSWI) is a serious complication of cardiac surgery
Treatment of DSWI has evolved from being based on conventional treatment with closed irrigation or application of muscle or omental flap after sternotomy wound debridement to primary application of negative pressure wound therapy followed by stable sternotomy wound reconstruction[1]
Retrospective 11 pts Negative pressure wound therapy (NPWT) vs. 9 In-hospital stay, therapy NPWT linked to shorter in-hospital stay (15 vs. 40.5 27 pts closed irrigation failure days, P=0.02) and lower therapy failure (0 vs. 5%, P=0.03) than closed irrigation

Summary

Introduction

Deep sternal wound infection (DSWI) is a serious complication of cardiac surgery. Even with implementation of modern treatment strategies, in-hospital mortality of DSWI widely ranges between 5.1-19% (ref.[1]). Extensive sternal debridement resulted in a lower risk of treatment failure when compared to closed irrigation. These showed comparable mortality results in early DSWI forms with absence of risk factors (class I and II), but with significantly shorter in-ICU stay length and in-hospital stay length in closed irrigation treatment[22,23].

Results

Conclusion