Kosuyolu Heart J 2013;16(2)
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Kosuyolu Heart J 2013;16(2):115-119 - doi: 10.5578/kkd.5004
Açık Kalp Cerrahisinden Sonra Derin Sternum Yara İnfeksiyonunda Negatif Basınçlı Yara Tedavisinin Rolü

Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

Cemalettin Aydın1, Halil Başel1, İbrahim Kara2, Yasin Ay1, Murat Songur3, Mehmet Yanartaş4,
Süleyman Yazıcı5


1 Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

2 Department of Cardiovascular Surgery, Emsey Hospital, Istanbul, Turkey

3 Department of Cardiovascular Surgery, High Specialization Training and Research Hospital, Ankara, Turkey

4 Department of Cardiovascular Surgery, Kosuyolu Heart Center, Kartal, Istanbul, Turkey

5 Department of Cardiovascular Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

ABSTRACT

Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of difficult wounds, including post-sternotomy mediastinitis.

Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A) and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B) between January 2006 and January 2010.

Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was significantly shorter in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B (p< 0.001). Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24%) patients in group B suffered recurrences. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days) (p= 0.001).

Conclusion: A significantly shorter healing time was confirmed with vacuum assisted closure. Hospital stay remained significantly shorter in group A (35 vs. 46 days).

Key Words: Negative-pressure wound therapy; mediastinitis; sternum; surgical wound infection; wound healing.

Received: 18.12.2012 Accepted: 19.03.2013

Correspondence

Dr. İbrahim Kara

Cevizli Mahallesi Anafartalar Caddesi

No: 5 Çalışkan Apartmanı Kat: 2 Daire: 3

Cevizli-Kartal/İstanbul, Türkiye

e-posta: ikara7881@hotmail.com

Açık Kalp Cerrahisinden Sonra Derin Sternum Yara İnfeksiyonunda Negatif Basınçlı Yara Tedavisinin Rolü

Açık Kalp Cerrahisinden Sonra Derin Sternum Yara İnfeksiyonunda
Negatif Basınçlı Yara Tedavisinin Rolü

Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

Cemalettin Aydın1, Halil Başel1, İbrahim Kara2, Yasin Ay1, Murat Songur3, Mehmet Yanartaş4,
Süleyman Yazıcı5


1 Bezmiâlem Vakıf Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye

1 Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

2 Emsey Hastanesi, Kalp ve Damar Cerrahisi Bölümü, İstanbul, Türkiye

2 Department of Cardiovascular Surgery, Emsey Hospital, Istanbul, Turkey

3 Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye

3 Department of Cardiovascular Surgery, High Specialization Training and Research Hospital, Ankara, Turkey

4 Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği,

Kartal, İstanbul, Türkiye

4 Department of Cardiovascular Surgery, Kosuyolu Heart Center, Kartal, Istanbul, Turkey

5 Dicle Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Diyarbakır, Türkiye

5 Department of Cardiovascular Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

ÖZET

Giriş: Mediyastinit kalp cerrahisinde yıkıcı bir komplikasyondur. En sık tedavi şekli debridman sonrası yaranın tekrar kapatılması ve mediyastenin antibiyotikle irrigasyonudur. Vakum yardımlı kapalı tedavi yöntemi son zamanlarda ortaya çıkmış bir tedavi tekniği olup, sternotomi sonrası mediyastinitler gibi zor yaralarda iyileşmeyi kolaylaştırmaktadır.

Hastalar ve Yöntem: Ocak 2006-Ocak 2010 tarihleri arasında derin sternal yara gelişen 41 hasta kullanılan tedavi yöntemine göre iki gruba ayrıldı. Mediyastinitli 22 hasta devamlı vakum destekli kapalı yöntemle tedavi edildi (grup A). On dokuz mediyastinitli hastaya antibiyotikle kapalı mediyastinal irrigasyon tedavisi uygulandı (grup B).

Bulgular: İki grup karşılaştırıldı. Grup B'den üç hasta tedavi sırasında kaybedildi. Ortalama iyileşme süresi grup A'da (13.5 ± 3.2 gün), grup B'ye (21.2 ± 16.4 gün) göre belirgin olarak daha kısa idi (p< 0.001). Vakum tedavisi sonrası hastalarda nüks görülmezken, grup B'de 7 (%24) hastada infeksiyon tekrarlamıştır. Hastanede kalım süresi grup A'da ortalama 30.5 (32.2 ± 11.3) gün, grup B'de ise ortalama 45 (49.2 ± 19.3) gün olup, grup A'da belirgin olarak daha kısa idi (p= 0.001).

Sonuç: Kapalı vakum sisteminde iyileşme süresi belirgin olarak kısa bulunmuştur. Hastanede kalım süresi grup A'da önemli oranda kısadır.

Anahtar Kelimeler: Negatif basınçlı yara tedavisi; mediyastinit; sternum; cerrahi yara infeksiyonu; yara iyileşmesi.

Geliş Tarihi: 18.12.2012 Kabul Tarihi: 19.03.2013

ABSTRACT

Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of difficult wounds, including post-sternotomy mediastinitis.

Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A) and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B) between January 2006 and January 2010.

Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was significantly shorter in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B (p< 0.001). Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24%) patients in group B suffered recurrences. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days) (p= 0.001).

Conclusion: A significantly shorter healing time was confirmed with vacuum assisted closure. Hospital stay remained significantly shorter in group A (35 vs. 46 days).

Key Words: Negative-pressure wound therapy; mediastinitis; sternum; surgical wound infection; wound healing.

Received: 18.12.2012 Accepted: 19.03.2013

Yazışma Adresi/Correspondence

Dr. İbrahim Kara

Cevizli Mahallesi Anafartalar Caddesi

No: 5 Çalışkan Apartmanı Kat: 2 Daire: 3

Cevizli-Kartal/İstanbul, Türkiye

e-posta: ikara7881@hotmail.com

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