![]() This is followed by ample debridement of the wound and surrounding soft tissue including antiseptic irrigation. At first, all treatment strategies follow the principles of septic surgery, such as opening the infected wound and subsequent removal of all foreign osteosynthetic material used for sternal closure, including necrotic sites and pus. These miserable outcomes historically required the development of further treatment procedures. Another devastating complication resulting from an open sternum is right ventricular laceration, which is associated with high mortality rates. Prolonged immobilization increases the risk of additional complications such as pneumonia, thrombosis, and muscle weakness. Thoracic instability and, subsequently, necessary mechanical ventilation are disadvantageous to secondary healing. However, this approach has a mortality rate of up to 45%. When heart surgery was in its early stages, DSWI was mostly treated with surgical revisions, including multiple open dressing changes and followed by sternal rewiring or secondary healing. Therapy for DSWI has changed several times over the last few years and has not been standardized yet. Introductionĭeep sternal wound infection (DSWI) is a severe complication after cardiac surgery with a frequency rate from 0.2% up to 8% and a mortality rate from 5% up to 50%. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing these treatment modalities are pivotal to define evidence for patients presenting with DSWI.ĭeep sternal wound infection, Poststernotomy mediastinitis, Vacuum-assisted closure, Primary reclosure, Suction/irrigation system 1. The current understanding is based purely on retrospective studies, not evidence-based medicine. ![]() Mostly, as a primary management of DSWI two treatment modalities are mainly in use: primary reclosure coupled with a double-tube suction/irrigation system and V.A.C. ® is used in 28/79 (35%) heart centers as the ‘first-line’ treatment, 22/79 (28%) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37%) clinics both treatment options were used according to intraoperative conditions. Therefore, a questionnaire with regards to the primary treatment modalities of DSWI was distributed to all 79 German heart surgery centers. The purpose of this study was to assess whether there is consensus of the primary management of DSWI using one method as a single line therapy or a combination of these procedures. ®) therapy, and primary or delayed flap closure. There are various primary treatment modalities of managing deep sternal wound infection (DSWI) following cardiac surgery, namely surgical debridement with primary reclosure in conjunction with irrigation, Vacuum-assisted closure (V.A.C.
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