Abstract
Amaç: Sternotomi sonrası mediastinit kalp cerrahisinin önemli sorunlarında birisidir. Mediastinit gelişen hastalarda mortalite ise hatrı sayılır derecede yüksektir. Negatif basınçlı yara kapama sistemi (VAK) yüzeyel kronik yaraların tedavisi amacı ile kullanılmaktadır. Biz de sternotomi ile opere ettiğimiz ve ameliyat sonrası yara yeri enfeksiyonu gelişen hastalardaki VAK kullanım tecrübelerimi paylaşmak istedik.
Gereç ve Yöntemler: 2014 yılından itibaren açık kalp cerrahisi geçirmiş olan 2474 hasta retrospektif olarak incelenilmiştir. Yara yerinde akıntı şikayeti ile başvurmuş toplam 87 hasta çalışmaya alınmıştır. 49 hastaya açık pansuman yapılmışken, 38 hastaya VAK tedavisi uygulanmıştır.
Bulgular: VAK tedavisi uygulanılan grubun yaş ortaması 63,35 ± 1,15 iken açık pansuman yapılan grupta 65,06 ± 2,94'tur. VAK tedavisi uygulanılan grubun BMI ortaması 27,83 ± 4,69 iken açık pansuman yapılan grupta 27,93 ± 4,68'tur. Mortalite açısından iki grup karşılaştırıldığındada iki grup arasında istatistiksel fark saptanmamıştır. VAK tedavisi uygulanılan grubun hastane ortalama yatış süresi 26,33 ± 11,67 iken açık pansuman yapılan grubunda 42,26 ± 5,24'tur. İki grup arasında istatistiksel olarak anlamlı fark mevcuttur (p˂0,005).
Sonuç: VAK sistemleri kalp cerrahisinin önemli bir komplikasyonu olan mediastinit tedavisinde iyi bir seçenektir. Her kliniğin uygulama yöntemleri değişik olsa dahi doğru kullanıldığında ciddi fayda gösterdiğini hem bizim hemde literatürdeki diğer çalışmalar net bir şekilde göstermiştir.
Keywords
References
- 1. Domkowski PW, Smith ML, Gonyon, DL, Drye C et al. Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thoracic and Cardiovasc Surg 2003; 126: 386-9
- 2. Gummert JF, Barten MJ, Hans C et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive patients. J Thorac Cardiovasc Surg 2002; 50: 87-91.
- 3. Milano CA, Kesler K, Archibald N et al. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995; 92: 2245-51.
- 4. Morykwas MJ, Argenta LC, Shelton B et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-62.
- 5. Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive patients. J Thorac Cardiovasc Surg 2002; 50: 87-91.
- 6. Milano CA, Kesler K, Archibald N, et al. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995; 92: 2245-51.
Abstract
Aim: Post-sternotomy mediastinitis is one of the important problems of cardiac surgery. Mortality in patients with mediastinitis is considerably high. Negative pressure wound closure system (VAC) is used for the treatment of superficial chronic wounds. We wanted to share our experiences with VAK use in patients who were operated with sternotomy and developed postoperative wound infection.
Material and Methods: 2474 patients who had undergone open heart surgery since 2014 were analyzed retrospectively. A total of 87 patients who applied with the complaint of the wound site infection were included in the study. While 49 patients were received only open wound dressings, 38 patients were received VAC treatment.
Results: The mean age of the group treated with VAK was 63.35 ± 1.15, while it was 65.06 ± 2.94 in the open dressing group. The mean BMI of the VAC treatment group was 27.83 ± 4.69, while it was 27.93 ± 4.68 in the open dressing group. When the two groups were compared in terms of mortality, there was no statistical difference between the two groups. The mean hospital stay of the VAK group was 26.33 ± 11.67, while it was 42.26 ± 5.24 in the open dressing group. There is a statistically significant difference between the two groups (p˂0.005).
Conclusion: VAC systems are a good option in the treatment of mediastinitis, which is an important complication of cardiac surgery. Both our and other studies in the literature have clearly shown that even if the application methods of each clinic are different, when used correctly, it has considerable benefits.
Keywords
References
- 1. Domkowski PW, Smith ML, Gonyon, DL, Drye C et al. Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thoracic and Cardiovasc Surg 2003; 126: 386-9
- 2. Gummert JF, Barten MJ, Hans C et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive patients. J Thorac Cardiovasc Surg 2002; 50: 87-91.
- 3. Milano CA, Kesler K, Archibald N et al. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995; 92: 2245-51.
- 4. Morykwas MJ, Argenta LC, Shelton B et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-62.
- 5. Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive patients. J Thorac Cardiovasc Surg 2002; 50: 87-91.
- 6. Milano CA, Kesler K, Archibald N, et al. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995; 92: 2245-51.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Orıgınal Artıcle |
| Authors | |
| Publication Date | June 30, 2021 |
| Published in Issue | Year 2021 |
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