Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis

Background and objective: Deep sternal wound infection is a feared complication of open-heart surgery. Negative pressure wound therapy has gained an important role in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy has been introduced as a method to prevent wound complications after sternotomy, and lately, after flap reconstructions in the treatment of deep sternal wound infection. We aimed to study if incisional negative pressure wound therapy with PICO™ had similar beneficial effect described earlier with competing commercial devices. Methods: This study included 82 patients treated with pectoralis major muscle flap for deep sternal wound infection during the years 2006–2020. PICO group consisted of 24 patients treated with preoperative negative pressure wound therapy and postoperative incisional negative pressure wound therapy (PICO™). Two control groups included 48 patients with conventional treatment and 10 patients with preoperative negative pressure wound therapy only. Results: In the PICO group, the complication rate declined from 50.0% to 33.30%, major complication rate from 29.2% to 12.5%, and need for an additional flap from 14.6.% to 4.2% when compared to conventional treatment. The length of hospital stay decreased as well. Preoperative negative pressure wound therapy alone was associated with moderate decline in the complication rates. In addition, we described the use of split pectoralis major muscle flap reconstruction in 57 patients. To our knowledge, this is the largest published patient series describing this method in the treatment of deep sternal wound infection. Conclusions: Incisional negative pressure wound therapy with PICO™ seems beneficial after flap reconstruction. Split pectoralis major muscle flap is a versatile reconstruction option suitable to be used as a workhorse in the treatment of deep sternal wound infection.

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Management of Deep Sternal Wound Infection: Complete Sternal Osteomyelitis

The Heart Surgery Forum ◽

10.1532/hsf.2805 ◽

2020 ◽

Vol 23 (3) ◽

pp. E281-E284

Author(s):

Khaled Ebrahim Al-Ebrahim

Keyword(s):

Cardiac Surgery ◽

Wound Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Rectus Abdominis ◽

Deep Sternal Wound Infection ◽

Sternal Wound Infection ◽

Wound Therapy ◽

Rectus Abdominis Flap ◽

Sternal Osteomyelitis

Deep sternal wound infection (DSWI) after cardiac surgery is a challenging complication that affects the outcome of surgery. The worst type of DSWI is mediastinitis and sternal osteomyelitis, which dramatically increase morbidity, mortality, and cost of care. This case report describes successful treatment of sternal osteomyelitis after open heart surgery with combined negative pressure wound therapy and rectus abdominis flap. This combination of negative pressure wound therapy with rectus abdominis flap in treating sternal osteomyelitis after open cardiac surgery is not well studied.

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

Kosuyolu Kalp Dergisi ◽

10.5578/kkd.5004 ◽

2013 ◽

Vol 16 (2) ◽

pp. 115-119

Author(s):

Cemalettin Aydın ◽

Halil Başel ◽

İbrahim Kara ◽

Yasin Ay ◽

Murat Songur ◽

...

Keyword(s):

Wound Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Heart Surgery ◽

Open Heart Surgery ◽

Deep Sternal Wound Infection ◽

Open Heart ◽

Sternal Wound Infection ◽

Wound Therapy

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A double Dacron patch repair for right ventricle rupture during negative-pressure wound therapy of deep sternal wound infection

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320957813 ◽

2020 ◽

pp. 021849232095781

Author(s):

Martin Simek ◽

Andrea Steriovsky ◽

Martin Kalab

Keyword(s):

Right Ventricle ◽

Wound Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Patch Repair ◽

Deep Sternal Wound Infection ◽

Sternal Wound Infection ◽

Wound Therapy ◽

Dacron Patch

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Effectiveness of Negative Pressure Wound Therapy With Instillation and Dwelling After Stoma Closure: A Retrospective and Propensity Score Matching Analysis

10.21203/rs.3.rs-639481/v1 ◽

2021 ◽

Author(s):

Yoshinori Yane ◽

Jin-ichi Hida ◽

Yasutaka Chiba ◽

Yusuke Makutani ◽

Hokuto Ushijima ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Negative Pressure ◽

Primary Closure ◽

Negative Pressure Wound Therapy ◽

Secondary Outcome ◽

Stoma Closure ◽

Wound Therapy ◽

Purse String ◽

Propensity Score Matching Analysis

Abstract The use of temporary diverting stoma has become more common in low colorectal anastomosis to reduce anastomotic complications. Surgical site infection (SSI) at the stoma closure site has been one of the most frequent postoperative complications. The aim of this study was to compare the short-term outcomes between conventional primary suture closure and negative pressure wound therapy with instillation and dwelling (NPWTi-d) therapy following purse-string suturing, using propensity score matching analysis. We retrospectively evaluated the medical records of 107 patients who underwent stoma closure between January 2016 and October 2020. The primary outcome was the proportion of SSI. The secondary outcome was the day of postoperative length of stay. Propensity score matching with one-to-one match was performed for reducing treatment selection bias. Of a total of 107 patients, 67 patients had been treated with conventional primary closure and 40 with NPWTi-d therapy. The propensity score matching derived 37 pairs. The respective SSI proportions were 0% and 16.2% in the groups with NPWTi-d and primary closure (P=0.025). The respective median days of postoperative hospital stay were 9.0 and 10.0 in the groups with NPWTi-d and primary closure (P=0.453). NPWTi-d therapy with purse-string suturing was effective in reducing SSI after stoma closure.

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Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1462.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 912-917 ◽

Cited By ~ 2

Author(s):

Muhammad Tahir ◽

Ejaz A. Chaudhry ◽

Faridullah K. Zimri ◽

Nadeem Ahmed ◽

Saeed A. Shaikh ◽

...

Keyword(s):

Wound Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Mean Difference ◽

Open Fractures ◽

Life Assessment ◽

Wound Therapy ◽

Significant Difference ◽

Gauze Dressing ◽

Secondary Outcomes

Aims It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. Methods This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. Results A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685). Conclusion Our study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings. Cite this article: Bone Joint J 2020;102-B(7):912–917.

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