Changes in the management of deep sternal wound infections: a 12-year review
Changes in the management of deep sternal wound infections: a 12-year review
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DOI：
10.1111/ans.13279
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发表时间：
2015-11-01
影响因子：
1.7
通讯作者：
Ricketts, Sophie
中科院分区：
文献类型：
--
作者：
Lonie, Sarah;Hallam, Jane;Ricketts, Sophie
背景：胸骨深部伤口感染（DSWI）是一种罕见但危及生命的心脏手术并发症，与发病率和死亡率增加有关。这些患者的治疗方法多年来不断发展，包括胸骨重新连接，纵隔冲洗，负压伤口治疗（NPWT）敷料或皮瓣修复。我们审查了我们对社会福利和社会发展倡议的管理变化及其成果。方法利用澳大利亚和新西兰心胸外科学会的数据库，在2002年6月至2014年9月期间，在墨尔本圣文森特医院接受了5472例心脏手术，其中42例被确定为需要再次手术的DSWI。收集了与社会福利和社会发展倡议的风险因素、管理战略和结果有关的数据。在使用NPWT敷料之前（2002年6月至2006年2月，n = 14）和NPWT已被定期用于DSWI管理（2006年3月起，n = 28）的患者进行比较。根据胸骨伤口皮瓣闭合的要求对患者进行比较。结果由于NPWT敷料的广泛使用，需要皮瓣关闭的胸骨感染（25例比42.8%）和最终关闭后的术后并发症（7.1例比28.6%）减少了。在广泛使用NPWT之前和之后，患者在关闭前需要的再手术次数相似，在最终关闭的时间或住院时间上没有显着差异。结论NPWT敷料作为最终闭合的桥梁，可减少重瓣重建的需要，不延迟最终重建或延长住院时间，并可减少重建后需要再次手术的并发症。
BackgroundDeep sternal wound infection (DSWI) is a rare but life-threatening complication following cardiac surgery associated with increased morbidity and mortality. Management of these patients has evolved over the years and can include sternal rewiring, mediastinal irrigation, negative-pressure wound therapy (NPWT) dressing or repair with flaps. We reviewed changes in our management of DSWI and outcomes.MethodsUsing the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, 5472 underwent cardiac surgery at St Vincent's Hospital, Melbourne, and 42 were identified as developing DSWI requiring re-operation between June 2002 and September 2014. Data were collected pertaining to risk factors for DSWI, management strategies and outcomes. Patients were compared from a period prior to NPWT dressing use (June 2002-February 2006, n = 14) and since the NPWT has been used regularly in the management of DSWI (from March 2006, n = 28). Patients were also compared based on the requirement for flap closure of their sternal wound.ResultsBecause of the widespread use of NPWT dressings, there is a trend towards fewer sternal infections requiring flap closure (25 versus 42.8%) and less post-operative complications after definitive closure (7.1 versus 28.6%). Before and after widespread NPWT use, patients require similar number of re-operations before closure and have no significant differences in time to definitive closure or length of hospital stay.ConclusionThe use of NPWT dressings as a bridge to definitive closure may reduce the need for more burdensome flap reconstruction, does not delay definitive reconstruction or prolong hospital stay and may reduce post-reconstruction complications requiring re-operation.