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Krauze A, Fus-Kujawa A, Bajdak-Rusinek K, Żyła-Uklejewicz D, Fernandez C, Bednarek I, Gałka S, Sieroń Ł, Bogunia E, Hermyt M, Nożyński J, Milewski K, Czekaj P, Wojakowski W. Impact of local delivery of allogeneic chondrocytes on the biological response and healing of the sternum bones after sternotomy. Sci Rep 2023; 13:15971. [PMID: 37749290 PMCID: PMC10520054 DOI: 10.1038/s41598-023-43255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023] Open
Abstract
Median sternotomy is the surgical method of choice for many procedures where one of the main problems is the long post-operative wound healing process leading to sternal dehiscence and the development of infection. This leads to prolonged hospital stay and increased mortality due to post-operative complications. A promising solution seems to be the use of allogeneic chondrocytes for wound treatment, whose properties in the field of cartilage reconstruction are widely used in medicine, mainly in orthopedics. In the present study, we investigated the effect of local delivery of allogeneic chondrocytes on the biological response and healing of the sternum after sternotomy. We optimized the culture conditions for the isolated chondrocytes, which were then applied to the sternal incision wound. Chondrocytes in the culture were assessed on the basis of the presence of chondrocyte-specific genes: Sox9, Aggrecan and Collagen II. In turn, the histopathological and immunohistochemical evaluation was used to assess the safety of implantation. In our work, we demonstrated the possibility of obtaining a viable culture of chondrocytes, which were successfully introduced into the sternal wound after sternotomy. Importantly, implantation of allogeneic chondrocytes showed no significant side effects. The obtained results open new possibilities for research on the use of allogeneic chondrocytes in the process of accelerating wound healing after median sternotomy.
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Affiliation(s)
- Agata Krauze
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Agnieszka Fus-Kujawa
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Karolina Bajdak-Rusinek
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland.
| | - Dorota Żyła-Uklejewicz
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Carlos Fernandez
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Ilona Bednarek
- Department of Biotechnology and Genetic Engineering, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055, Katowice, Poland
| | - Sabina Gałka
- Department of Biotechnology and Genetic Engineering, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055, Katowice, Poland
| | - Łukasz Sieroń
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Edyta Bogunia
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Mateusz Hermyt
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Jerzy Nożyński
- Department of Histopathology, Silesian Centre for Heart Diseases, 41-800, Zabrze, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Piotr Czekaj
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Pađen L, Griffiths J, Cullum N. “Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound. Int J Qual Stud Health Well-being 2022; 17:2123932. [PMID: 36102138 PMCID: PMC9481149 DOI: 10.1080/17482631.2022.2123932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. Methods A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. Results We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”. Conclusion Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.
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Affiliation(s)
- Ljubiša Pađen
- Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
- Research & Innovation Division, Manchester University NHS Foundation Trust Research Office, Manchester, UK
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Morrell Scott N, Lotto RR, Spencer E, Grant MJ, Penson P, Jones ID. Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature. Heart Lung 2022; 55:89-101. [PMID: 35504241 DOI: 10.1016/j.hrtlng.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Around 36,000 cardiac operations are undertaken in the United Kingdom annually, with most procedures undertaken via median sternotomy. Wound complications occur in up to 8% of operations, with an associated mortality rate of around 47% in late or undetected cases. OBJECTIVE To undertake a systematised literature review to identify pre-operative, peri-operative and post-operative risk factors associated with sternal wound complications. METHODS Healthcare databases were searched for articles written in the English language and published between 2013 and 2021. Inclusion criteria were quantitative studies involving patients undergoing median sternotomy for cardiac surgery; sternal complications and risk factors. RESULTS 1360 papers were identified, with 25 included in this review. Patient-related factors included: high BMI; diabetes; comorbidities; gender; age; presenting for surgery in a critical state; predictive risk scores; vascular disease; severe anaemia; medication such as steroids or α-blockers; and previous sternotomy. Peri-operative risk increased with specific types and combinations of surgical procedures. Sternal reopening was also associated with increased risk of sternal wound infection. Post-operative risk factors included a complicated recovery; the need for blood transfusions; respiratory complications; renal failure; non-diabetic hyperglycaemia; sternal asymmetry and sepsis. CONCLUSION Pre, peri and post-operative risk factors increase the risk of sternal wound complications in cardiac surgery. Generic risk assessment tools are primarily designed to provide mortality risk scores, with their ability to predict risk of wound infection questionable. Tools that incorporate factors throughout the operative journey are required to identify patients at risk of surgical wound infection.
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Affiliation(s)
- N Morrell Scott
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Sciences, United Kingdom
| | - R R Lotto
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Sciences, United Kingdom.
| | - E Spencer
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, United Kingdom
| | - M J Grant
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, United Kingdom
| | - P Penson
- School of Pharmacy and Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, United Kingdom; Liverpool Centre for Cardiovascular Sciences, United Kingdom
| | - I D Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Sciences, United Kingdom
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Lender O, Göbölös L, Bajwa G, Bhatnagar G. Sternal wound infections after sternotomy: risk factors, prevention and management. J Wound Care 2022; 31:S22-S30. [PMID: 35678775 DOI: 10.12968/jowc.2022.31.sup6.s22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A serious complication after cardiac surgery is sternal wound infection. Although incidence rates vary worldwide, this complication raises significant concern in a certain patient demographic. This article uses risk assessment strategies to identify a high-risk patient profile and draws parallels with positive predictors in the preoperative, intraoperative and postoperative setting. It describes the complexity of sternal wound infections and highlights guidelines on detection and treatment. The optimal goal of this article is to help minimise the incidence of sternal wound complications after sternotomy by discussing recommendations for preoperative, intraoperative and postoperative preventive measures.
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Affiliation(s)
- Olga Lender
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Laszlo Göbölös
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Gurjyot Bajwa
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Gopal Bhatnagar
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
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Ardigò A, Francica A, Veraldi GF, Tropea I, Tonelli F, Rossetti C, Onorati F, Faggian G. Value of Perioperative Chest X-ray for the Prediction of Sternal Wound Complications after Cardiac Surgery in High-Risk Patients: A "Work in Progress" Analysis. J Clin Med 2021; 10:jcm10020207. [PMID: 33430141 PMCID: PMC7827951 DOI: 10.3390/jcm10020207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sternal wound complications are serious events that occur after cardiac surgery. Few studies have investigated the predictive value of chest X-ray radiological measurements for sternal complications. METHODS Several perioperative radiological measurements at chest X-ray and clinical characteristics were computed in 849 patients deemed at high risk for sternal dehiscence (SD) or More than Grade 1 Surgical Site Infection (MG1-SSI). Multivariable analysis identified independent predictors, whilst receiver operating characteristics (ROC) curve analyses highlighted cut-off values of radiological measurements for the prediction of both complications. RESULTS SD occurred in 8.8% of the patients, MG1-SSI in 6.8%. Chronic obstructive pulmonary disease (COPD) was the only independent predictor for SD (Odds Ratio, O.R. 12.1; p < 0.001); proximal sternal height (PSH) was the only independent protective factor (O.R. 0.58; p < 0.001), with a cut-off value of 11.7 mm (sensitivity 70.5%, specificity 71.0%; ROC area under the curve (AUC) = 0.768, p < 0.001). Diabetes mellitus (O.R. 3.5; p < 0.001) and COPD (O.R. 21.3; p < 0.001) were independent predictors for MG1-SSI; indexed proximal sternal height (iPSH) was as a protective factor (O.R. 0.26; p < 0.001) with a cut-off of 5.97 mm (sensitivity 70.2%, specificity 69.0%; ROC AUC = 0.739, p < 0.001). No other radiological measurements were independently correlated with SD or MG1-SS (p = N.S.). CONCLUSION PSH and iPSH at preoperative chest X-ray may act as indicators of high risk for sternal wound complications, allowing for early preventative measures.
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Affiliation(s)
- Andrea Ardigò
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
| | | | - Ilaria Tropea
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
| | - Filippo Tonelli
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
- Correspondence: ; Tel.: +39-045-8123307
| | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy; (A.A.); (A.F.); (I.T.); (F.T.); (C.R.); (G.F.)
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