Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing...Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.展开更多
Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which incr...Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.展开更多
Postopereative sternal dehiscence is one of the most important complications of median sternotomy which may cause pulmonary dysfunction and mediastinitis. We are reporting a patient with sternal dehiscence after coron...Postopereative sternal dehiscence is one of the most important complications of median sternotomy which may cause pulmonary dysfunction and mediastinitis. We are reporting a patient with sternal dehiscence after coronary artery bypass surgery that underwent application of thermoreactive nitinol clips in addition to Robicsek procedure. Using thermoreactive nitinol clips method together with Robicsek procedure may be a valuable technique for preventing recurrent sternal dehiscence for patients who are candidates of noninfective recurrent sternal dehiscence.展开更多
<strong>Purpose:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">We harvested bilateral Internal Mammary Arteries and made LIMA-R...<strong>Purpose:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlock展开更多
文摘Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.
文摘Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.
文摘Postopereative sternal dehiscence is one of the most important complications of median sternotomy which may cause pulmonary dysfunction and mediastinitis. We are reporting a patient with sternal dehiscence after coronary artery bypass surgery that underwent application of thermoreactive nitinol clips in addition to Robicsek procedure. Using thermoreactive nitinol clips method together with Robicsek procedure may be a valuable technique for preventing recurrent sternal dehiscence for patients who are candidates of noninfective recurrent sternal dehiscence.
文摘<strong>Purpose:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlock
