Tewarie Lachmandath, Moza Ajay Kumar, Zayat Rashad, Autschbach Rüdiger, Goetzenich Andreas, Menon Ares Krishna
Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
Eur J Cardiothorac Surg. 2015 May;47(5):e180-7; discussion e187. doi: 10.1093/ejcts/ezv007. Epub 2015 Feb 11.
Using an ultrasonic debridement system (low frequency, 25 kHz), we aimed to completely remove bacterial biofilms and preserve vital sternal tissue and to compare this procedure with conventional surgical therapy.
In this retrospective study, we evaluated 37 consecutive patients (25 males) between April 2011 and June 2013 in whom sternocutaneous fistula (SCF) was treated with the ultrasound-assisted wound (UAW) system (Group A, n = 18) or with conventional surgical therapy (Group B, n = 19). Treatment in Group A consisted of a complete dissection of the SCF followed by a multistep UAW debridement session after an interval of 3 days. Our final step in both groups was secondary wound closure with a musculocutaneous flap.
Patients in both groups were categorized as high risk with respect to several of the known SCF risk factors. In both groups, a similar variety of bacteria were isolated: 61% were gram-positive species, 16.5% were gram-negative species and 10.5% were Candida albicans. Time to secondary wound closure following eradication was significantly shorter in Group A (10 ± 5.4 vs 15 ± 7.1 days in Group B, P = 0.012). Postoperative antibiotic treatment time (16 ± 9.3 vs 22 ± 10.7 days in Group B, P = 0.078) showed a trend in favour of Group A, but the mean hospitalization time (22 ± 12.0 vs 26 ± 14.3 days in Group B, P = 0.34) did not differ between groups. Recurrence of SCF tended to be less frequent in Group A (6 vs 21% in Group B, P = 0.46). In Group B, one infection-related death was noted. The mean follow-up time was 8 ± 2.7 (Group A) and 10 ± 5.7 (Group B) months.
Ultrasonic debridement is a promising adjunct to SCF treatment. In combination with adequate surgical and antimicrobial therapy, we documented good mid-term results in our trial group.
使用超声清创系统（低频，25千赫），我们旨在完全清除细菌生物膜并保留重要的胸骨组织，并将此方法与传统手术治疗进行比较。
在这项回顾性研究中，我们评估了2011年4月至2013年6月期间连续37例患者（25例男性），这些患者的胸骨皮肤瘘（SCF）采用超声辅助伤口（UAW）系统治疗（A组，n = 18）或传统手术治疗（B组，n = 19）。A组的治疗包括完全切除SCF，然后在间隔3天后进行多步骤UAW清创术。两组的最后一步都是用肌皮瓣进行二期伤口闭合。
两组患者在几个已知的SCF危险因素方面均被归类为高危。两组分离出的细菌种类相似：61%为革兰氏阳性菌，16.5%为革兰氏阴性菌，10.5%为白色念珠菌。根除后二期伤口闭合的时间在A组明显更短（10±5.4天对B组的15±7.1天，P = 0.012）。术后抗生素治疗时间（A组为16±9.3天对B组的22±10.7天，P = 0.078）显示出有利于A组的趋势，但两组的平均住院时间（A组为22±12.0天对B组的26±14.3天，P = 0.34）没有差异。SCF的复发在A组往往不太频繁（6%对B组的21%，P = 0.46）。在B组，记录到1例与感染相关的死亡。平均随访时间为A组8±2.7个月和B组10±5.7个月。
超声清创是SCF治疗的一种有前景的辅助方法。与适当的手术和抗菌治疗相结合，我们在试验组记录到了良好的中期结果。
