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Simek M, Chudoba A, Hajek R, Tobbia P, Molitor M, Nemec P. From open packing to negative wound pressure therapy: A critical overview of deep sternal wound infection treatment strategies after cardiac surgery. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:263-271. [PMID: 30215435 DOI: 10.5507/bp.2018.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Deep sternal wound infection is a challenging aspect of modern cardiac surgery. The considerable mortality rate, devastating morbidity and, negative impact on long-term survival has driven cardiac and plastic surgeons to seek a more advantageous treatment solution. This review summarizes progress in the field of deep sternal wound infection treatment after cardiac surgery. Emphasis is placed on outcomes analysis of contemporary treatment strategy based on negative pressure wound therapy followed by sternotomy wound reconstruction, and its comparison with conventional treatment modalities used afore. Furthermore, complications and drawbacks of treatment strategies are critically evaluated to outline current options for successfully managing this life-threatening complication following cardiac surgery.
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Affiliation(s)
- Martin Simek
- Department of Cardiac Surgery, University Hospital Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Adam Chudoba
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Roman Hajek
- Department of Cardiac Surgery, University Hospital Olomouc, Czech Republic
| | - Patrick Tobbia
- Department of Cardiovascular Medicine, Regional Medical Center, 624 Hospital Drive, Mountain Home, United States
| | - Martin Molitor
- Department of Plastic Surgery, Hospital Na Bulovce, Prague, Czech Republic
| | - Petr Nemec
- Centre for Cardiovascular and Transplant Surgery, Brno, Czech Republic
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Dell'Amore A, Campisi A, Giunta D, Congiu S, Dolci G, Murana G, Suarez SM, Daddi N. Surgical options to treat massive sternal defect after failed Robicsek procedure. J Thorac Dis 2018; 10:E410-E415. [PMID: 30069394 DOI: 10.21037/jtd.2018.06.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Andrea Dell'Amore
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Alessio Campisi
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Domenica Giunta
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Stefano Congiu
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Giampiero Dolci
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Giacomo Murana
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Sofia Martin Suarez
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Niccolò Daddi
- Department of Cardiothoracic Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
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De Palma A, Sollitto F, Loizzi D, Di Gennaro F, Scarascia D, Carlucci A, Giudice G, Armenio A, Ludovico R, Loizzi M. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system. J Thorac Dis 2016; 8:490-8. [PMID: 27076945 DOI: 10.21037/jtd.2016.02.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. METHODS We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. RESULTS Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. CONCLUSIONS An optimal chest wall stabilization and reconstruction was achieved with the Synthes(®) titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain.
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Affiliation(s)
- Angela De Palma
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Sollitto
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Loizzi
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Daniele Scarascia
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Carlucci
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Giudice
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Armenio
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Rossana Ludovico
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Michele Loizzi
- 1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
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