Wire Cerclage Versus Cable Closure After Sternotomy for Dehiscence and DSWI: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 15 (4) ◽  
pp. 322-328
Author(s):  
Apurva Dixit ◽  
Derrick Y. Tam ◽  
Monica Yu ◽  
Bobby Yanagawa ◽  
Mario Gaudino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Infection ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Sternal Dehiscence ◽  
Wire Cerclage ◽  
Lower Pain ◽  
Potential Alternative

Objective Cable closure has been introduced as a potential alternative to traditional wire cerclage (WC) for closure of median sternotomy. To evaluate whether cable closure improves patient outcomes, we conducted a systematic review and meta-analysis of the literature. Methods Ovid versions of Medline and Embase, and Google Scholar were used for the literature search. This yielded 7 studies ( n = 2,758), which compared traditional WC to cable closure systems. Outcomes included deep sternal wound infection, sternal dehiscence, postoperative pain score, and sternal wound infection. Results We found significantly lower incidence of sternal dehiscence for cable closure compared to WC (risk ratio [RR] 0.14, 95% confidence interval [CI]: 0.03 to 0.59 , P < 0.01 , I 2 = 0%) but no difference in DSWI (RR 0.97, 95% CI: 0.39 to 2.42, P = 0.95, I 2 = 33%). Cable closure was also associated with lower pain when compared with the WC group (mean difference −1.04 points, 95% CI: −1.89 to −0.19 , P = 0.02, I 2 = 87%). Conclusions This study suggests that cable closure results in less incidence of sternal dehiscence and pain compared to WC. Nonetheless, there remains a limited number of studies on this topic and further high-quality studies are required to confirm the results of this meta-analysis.

scholarly journals Antibiotic-loaded bone cement combined with vacuum sealing drainage to treat deep sternal wound infection following cardiac surgery: the first case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xia Jiang ◽  
Fanyu Bu ◽  
Yong Xu ◽  
Zhaohui Jing ◽  
Guoqing Jiao ◽  
...  
Keyword(s):  
Case Report ◽  
Wound Infection ◽  
Bone Cement ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Stage I ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Sealing ◽  
Vacuum Sealing Drainage

Abstract Background Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. Case presentation This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient’s wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. Conclusions The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.

scholarly journals Retrospective Analysis of Flap Based Management in Deep Sternal Wound Infection in a Tertiary Care Centre –A Single Centre Study

2021 ◽  
Vol 9 (2) ◽  
pp. 69-72
Author(s):  
Sartaj Guroo ◽  
Ajit Padhy ◽  
Khushwant Popli ◽  
Ridhika Munja ◽  
Navnita Kisko ◽  
...  
Keyword(s):  
Wound Infection ◽  
Heart Surgery ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Muscle Flap ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Flap Surgery ◽  
Fascial Flap

Aims: In this retrospective study we analyzed the outcomes of flap based management in deep sternal wound infection (DSWI). Materials & Methods: Patients, who had undergone open heart surgery through median sternotomy between September 2017 and March 2020 and had developed deep sternal infections, were retrospectively analyzed in this study. Few patients found to have DSWI were managed only by Negative Pressure Wound Therapy (NPWT) and few were managed by NPWT and Bipectoral musculo fascial flap cover. The outcomes in terms of mortality and readmission in the postoperative course were obtained from the records during subsequent follow ups in OPD for six months. Results: Out of 925 patients 11 patients (1.2%) had deep sternal wound infection There were six patients (n=6, 54.55%) who received NPWT where as five patients (n=5, 45.45 %) received flap surgery following NPWT. The patient who underwent Flap surgery had a longer postoperative stay than NPWT group (46.2+/- 22.21, C.I 95%) days Vs (25.5+/- 14.41, C.I 95%) days. However, the readmission due to recurrence of infection was seen only in NPWT group (n=3, 50%) with in the period of six months following discharge. One patient out of the three readmitted patients expired due to sepsis. Conclusion: NPWT followed by bipectoral muscle flap closure has a better surgical outcome than NPW alone in deep sternal wound infection in early postoperative period

scholarly journals Antibiotic-Loaded Bone Cement Combined With Vacuum Sealing Drainage To Treat Deep Sternal Wound Infection Following Cardiac Surgery: The First Case Report

2021 ◽  
Author(s):  
Xia Jiang ◽  
Fanyu Bu ◽  
Yong Xu ◽  
Zhaohui Jing ◽  
GUOqing Jiao ◽  
...  
Keyword(s):  
Case Report ◽  
Wound Infection ◽  
Bone Cement ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Stage I ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Sealing ◽  
Vacuum Sealing Drainage

Abstract Background: Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement(ALBC) combined with vacuum sealing drainage(VSD) of DSWI.Case presentation: This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for two weeks until the inflammatory markers decreased to normal. One month after the surgery, patient’s wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment.Conclusions: The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.

scholarly journals Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery

2020 ◽  
Author(s):  
Feng Song ◽  
Zhenzhong Liu
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Median Sternotomy ◽  
Advancement Flap ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Assisted Closure ◽  
Sternal Wound Infections ◽  
Vacuum Assisted Closure Therapy ◽  
Deep Sternal Wound Infections

Abstract Objectives: The median sternotomy is the most common surgical approach for cardiac surgery. Deep sternal wound infection is a fatal complication after median sternotomy. The aim of this study was to evaluate the therapeutic effect of Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy on rehabilitation for the treatment of deep sternal wound infection after cardiac surgery.Methods: Between January 2016 to January 2018, 21 patients (10 males, 11 females) with deep sternal wound infection after cardiac surgery underwent Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy. These patients were followed-up 12 months postoperative. The patient characteristics, duration of vacuum-assisted closure therapy, the mean hospital stay, postoperative complications, long-term survival of patients were retrospectively analyzed.Results: Most patients undergone 1–3 times vacuum-assisted closure treatment sessions before closure. All patients were cured to discharge, the mean hospital stay was 21.1 days. Most patients’ healing wounds were first-stage healing, only one patient’s wound was second-stage healing, none was third-stage healing. One patient developed pulmonary infection and respiratory failure during the 12-month follow-up. None of the patients died during follow-up.Conclusions: Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery can shorten the hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group, the number of inferences is limited, so further large-scale controlled studies are needed.

scholarly journals Initial Report of a New Suture Cerclage Tape for Sternal Closure

2021 ◽  
Author(s):  
Paul DiGiorgi
Keyword(s):  
Wound Infection ◽  
Bone Fractures ◽  
Steel Wire ◽  
Long Bone ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Initial Report ◽  
Sternal Closure ◽  
Measurable Amount ◽  
Wire Cerclage

PURPOSE: We sought to evaluate a new, flexible suture cerclage tape for sternal closure after cardiac surgery. DESCRIPTION: Fiber Tape (Arthrex, Naples, FL, USA) suture cerclage has been successfully utilized in the stabilization of long bone fractures. For sternal closure, it is placed similarly to wire cerclage. Uniquely, it allows a measurable amount of tension to be applied to the sternum and it is at least twice as strong as stainless steel wire. We hypothesized this new flexible tape would provide short term safety and efficacy, as measured by incidence of deep sternal wound infection. EVALUATION: We performed a retrospective, single center analysis of adult patients undergoing sternotomy closure with FT. The observed incidence of deep sternal wound infection (DSWI) was compared to the expected incidence calculated through the Society of Thoracic Surgery (STS) risk calculator. A total of 45 patients were closed with FT. No patients suffered DSWI. Thirty of the 45 patients had STS risk calculations. For these 30 patients, the expected rate of DSWI was 0.2%. CONCLUSIONS: Despite study limitations, FT appears to be a safe method for sternal closure.

scholarly journals Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery

2020 ◽  
Author(s):  
Feng Song ◽  
Zhenzhong Liu
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Median Sternotomy ◽  
Advancement Flap ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Assisted Closure ◽  
Sternal Wound Infections ◽  
Vacuum Assisted Closure Therapy

Abstract Objectives: The median sternotomy is the most common surgical approach for cardiac surgery. Deep sternal wound infection is a fatal complication after median sternotomy. The aim of this study was to evaluate the therapeutic effect of Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy on rehabilitation for the treatment of deep sternal wound infection after cardiac surgery. Methods: Between January 2016 to January 2018, 21 patients (10 males, 11 females) with deep sternal wound infection after cardiac surgery underwent Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy. These patients were followed-up 12 months postoperative. The patient characteristics, duration of vacuum-assisted closure therapy, the mean hospital stay, postoperative complications, long-term survival of patients were retrospectively analyzed. Results: Most patients undergone 1–3 times vacuum-assisted closure treatment sessions before closure. All patients were cured to discharge, the mean hospital stay was 21.1 days. Most patients’ healing wounds were first-stage healing, only one patient’s wound was second-stage healing, none was third-stage healing. One patient developed pulmonary infection and respiratory failure during the 12-month follow-up. None of the patients died during follow-up.Conclusions: Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery can shorten the hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group, the number of inferences is limited, so further large-scale controlled studies are needed.

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