Invited Commentary

Abstract

Surgical site infections (SSIs) are the third most commonly reported nosocomial infection after cardiac surgery. The most devastating form is post-sternotomy mediastinitis, which seldom occurs but is associated with high mortality, morbidity, and serious economic burdens. In the majority of cases, the endogenous flora is the origin of involved microbes; therefore, preventive measures are used to reduce microbial contamination such as skin decolonization, shaving, skin decontamination, antibiotic prophylaxis, and minimal invasive access. Today, many cardiac surgical procedures can be performed by a limited access, avoiding full sternotomy. Mitral and tricuspid valve diseases can be treated surgically through a right mini-thoracotomy. Often, a left mini-thoracotomy is suitable access for coronary artery revascularization or aortic valve replacement. Furthermore, partial sternotomy or para-sternotomy access can be used for aortic valve surgery and for more demanding procedures, such as aortic surgery. Nevertheless, many cardiac surgical procedures are facilitated by standard sternotomy; therefore, it is of great interest to develop new strategies to prevent SSI in patients undergoing full sternotomy or partial sternotomy. Vestergaard and colleagues [1Vestergaard R.F. Nielsen P.H. Terp K.A. Søballe K. Andersen G. Hasenkam J.M. The effect of hemostatic material on sternal healing after cardiac surgery.Ann Thorac Surg. 2014; 97: 153-160Scopus (20) Google Scholar] investigate the effects of different hemostatic materials on sternal healing after cardiac surgery. The study demonstrates that radiologic bone healing is not completed 3 months after surgery. This information is useful for sternal wire removal, if needed, because generally this is done as early as 3 months postoperatively. Although bone healing is not completed in 3 months, a water-soluble polymer wax (Ostene; Ceremed Inc, Los Angeles, CA), compared with standard bone wax, was associated with a statistically significant improvement as documented by semiquantitative computed tomography analysis. This finding correlated with a better physical functionality score in favor of the Ostene group. This aspect of the study is crucial and unique because quality of life is pivotal in this study. Another important issue, pointed out by the authors, is that Ostene is a plausible alternative to bone wax if topic hemostasis is required. Many procedures can be performed without any kind of topic sternal hemostatic material. The number of patients in this study is limited; therefore, no plausible correlation between the different topic hemostatic agents and occurrence of SSI can be made. To investigate this, a large prospective randomized multicenter study is needed. Effect of Hemostatic Material on Sternal Healing After Cardiac SurgeryThe Annals of Thoracic SurgeryVol. 97Issue 1PreviewPostoperative sternal infection and dehiscence cause increased morbidity, mortality, and socioeconomic costs as well as patient discomfort and pain. Some predisposing factors have been uncovered but others remain uninvestigated. Among these are the influence of topical hemostatic agents such as bone wax (BW) and Ostene (Ceremed Inc, Los Angeles, CA) a new, water-soluble polymer wax (WSW). The object of this study was to investigate the impact of topical hemostatic agents on sternal healing in patients. Full-Text PDF