Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

Yıl 2013, Cilt: 16 Sayı: 2, 115 - 119, 01.02.2012

Cemalettin Aydın Halil Başel İbrahim Kara Yasin Ay Murat Songur Mehmet Yanartaş Süleyman Yazıcı

https://doi.org/10.5578/kkd.5004

Öz

Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of diffi cult wounds, including post-sternotomy mediastinitis. Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A) and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B) between January 2006 and January 2010. Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was signifi cantly shorter in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B (p< 0.001). Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24%) patients in group B suffered recurrences. Hospital stay was signifi cantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days) (p= 0.001). Conclusion: A signifi cantly shorter healing time was confi rmed with vacuum assisted closure. Hospital stay remained signifi cantly shorter in group A (35 vs. 46 days).

Anahtar Kelimeler

Negative-pressure wound therapy; mediastinitis; sternum; surgical wound infection;wound healing.

Açık Kalp Cerrahisinden Sonra Derin Sternum Yara İnfeksiyonunda Negatif Basınçlı Yara Tedavisinin Rolü

Öz

Giriş: Mediyastinit kalp cerrahisinde yıkıcı bir komplikasyondur. En sık tedavi şekli debridman sonrası yaranın tekrar kapatılması ve mediyastenin antibiyotikle irrigasyonudur. Vakum yardımlı kapalı tedavi yöntemi son zamanlarda ortaya çıkmış bir tedavi tekniği olup, sternotomi sonrası mediyastinitler gibi zor yaralarda iyileşmeyi kolaylaştırmaktadır. Hastalar ve Yöntem: Ocak 2006-Ocak 2010 tarihleri arasında derin sternal yara gelişen 41 hasta kullanılan tedavi yöntemine göre iki gruba ayrıldı. Mediyastinitli 22 hasta devamlı vakum destekli kapalı yöntemle tedavi edildi (grup A). On dokuz mediyastinitli hastaya antibiyotikle kapalı mediyastinal irrigasyon tedavisi uygulandı (grup B). Bulgular: İki grup karşılaştırıldı. Grup B'den üç hasta tedavi sırasında kaybedildi. Ortalama iyileşme süresi grup A'da (13.5 ± 3.2 gün), grup B'ye (21.2 ± 16.4 gün) göre belirgin olarak daha kısa idi (p< 0.001). Vakum tedavisi sonrası hastalarda nüks görülmezken, grup B'de 7 (%24) hastada infeksiyon tekrarlamıştır. Hastanede kalım süresi grup A'da ortalama 30.5 (32.2 ± 11.3) gün, grup B'de ise ortalama 45 (49.2 ± 19.3) gün olup, grup A'da belirgin olarak daha kısa idi (p= 0.001). Sonuç: Kapalı vakum sisteminde iyileşme süresi belirgin olarak kısa bulunmuştur. Hastanede kalım süresi grup A'da önemli oranda kısadır.

Anahtar Kelimeler

Negatif basınçlı yara tedavisi; mediyastinit; sternum; cerrahi yara infeksiyonu; yara iyileşmesi.

Kaynakça

• Shumacker HB Jr, Mandelbaum I. Continuous antibiotic irrigation in the treatment of infection. Arch Surg 1963;86:384-7.
• Jurkiewicz MJ, Bostwick J, Hester TR, Bishop JB, Craver J. In- fected median sternotomy wound: succesful treatment by muscle fl aps. Ann Surg 1980;191:738-44.
• Domkowski PW, Smith ML, Gonyon DL, et al. Evaluation of vacu- um assisted closure in the treatment of post-sternotomy mediasti- nitis. J Thorac Surg 2003;126:386-90.
• Morykwas MJ, Argenta LC, Shelton-Brown El, Mcguirt W. Vacu- um assisted closure. A new method for wound control and treat- ment: animal studies and basic foundations. Ann Plast Surg 1997;38:553-62.
• The Parisian Mediastinitis Study Group. Risk factors for deep ster- nal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 1996;111:1200-7.
• Sakamato H, Fukuda I, Oosaka M, Nakata H. Risk factors and treatment of deep sterna wound infection after cardiac operation. Ann Thorac Cardiovasc Surg 2003;9:226-32.
• Serry C, Bleck PC, Javid H, Hunter JA, Goldin MD, DeLaria GA, et al. Sternal wound complications. Management and results. J Thorac Cardiovasc Surg 1980;80:861-7.
• Obdeijn MC, de Lange MY, Lichtendahl DH, de Boer WJ. Vacuum assisted closure in the treatment of post-sternotomy mediastinitis. Ann ThoracSurg 1999;68:2358-60.
• De Feo M, Renzulli A, Ismeno G, Gregorio R, Della Corte A, Utili R, et al. Variables predicting adverse outcome in patients with deep sternal wound infection. Ann Thorac Surg 2001;71:324-31.
• Trouillet JL, Chastre J, Fagon JY, Pierre J, Domart Y, Gibert C. Use of granulated sugar in treatment of open mediastinitis after cardiac surgery. Lancet 1985;2:180-4.
• Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997;38:563-77.
• Wackenfors A, Gustafsson R, Sjögren J, Algotsson L, Ingemans- son R, Malmsjo M. Blood fl ow responses in the peristernal thorac- ic wall during vacuum-assisted closure therapy. Ann Thorac Surg 2005;79:1724-31.
• Sjogren J, Gustafsson R, Nilsson J, Malmsjo M, Ingemansson R. Clinical outcome after post-sternotomy mediastinitis: vacuum- assisted closure versus conventional treatment. Ann Thorac Surg 2005;79:2049-55.
• Mohan SS, McDermott BP, Cunha BA. Methicillin-resistant Staph- ylococcus aureus prosthetic aortic valve endocarditis with paraval- vular abscess treated with daptomycin. Heart Lung 2005;34:69-71.
• O’Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg 2005;79:1196-200.