Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria.
Department of Surgery, Georgi Stranski University Hospital, Pleven, Bulgaria.
Heart Surg Forum. 2022 Aug 21;25(4):E601-E607. doi: 10.1532/hsf.4791.
Sternal wound infection, especially deep sternal wound infection, is a serious complication after open heart surgery. It leads to a marked increase in hospital stay, financial expenses, and mortality. Treatment is primarily surgical and may be divided into conventional treatment methods and negative pressure wound therapy.
Between 2010 and 2021, 77 patients presenting back after cardiac surgery with deep sternal wound infection were treated surgically. Conventional treatment methods were utilized in 45 patients and included wound revision with primary closure, continuous wound irrigation, and open treatment with secondary closure. Negative-pressure wound therapy (NPWT) was applied in 32 patients. The two treatment arms were compared by two primary outcomes - rate of recurrent infection and hospital mortality. Predictors of mortality and infectious recurrence were identified using multivariate logistic regression.
Recurrent infection occurred in 18.2% of cases and mortality was 13% in the whole group. NPWT was more successful in preventing recurrent infection OR: 5.4 (95% CI: 1.1-27.5; P = 0.044) than conventional treatment and more than moderate left ventricular systolic dysfunction (EF<40%) predisposed to infectious recurrence - OR: 4.7 (95% CI: 1.05-22.1; P = 0.049). Recurrent infection itself was the strongest predictor of mortality in the multivariate model OR: 0.14 (95% CI: 0.03 - 0.58; P = 0.007).
NPWT as an initial method of wound preconditioning followed by definitive wound closure effectively reduces the rate of infectious recurrence and patient mortality. It may become the modality of first choice when dealing with complicated incisional infections following heart surgery.
胸骨伤口感染，尤其是深部胸骨伤口感染，是心脏直视手术后的严重并发症。它会导致住院时间明显延长、经济费用增加和死亡率升高。治疗主要是手术，可分为常规治疗方法和负压伤口治疗。
2010 年至 2021 年间，77 例心脏手术后出现深部胸骨伤口感染的患者接受了手术治疗。45 例患者采用常规治疗方法，包括一期缝合的伤口修正、持续伤口冲洗和二期闭合的开放性治疗。32 例患者应用负压伤口治疗（NPWT）。通过两个主要结局（复发性感染率和医院死亡率）比较两种治疗方法。使用多变量逻辑回归识别死亡率和感染复发的预测因素。
全组病例复发性感染发生率为 18.2%，死亡率为 13%。NPWT 预防复发性感染的成功率高于常规治疗（OR：5.4，95%CI：1.1-27.5；P=0.044），中度左心室收缩功能障碍（EF<40%）更容易发生感染复发（OR：4.7，95%CI：1.05-22.1；P=0.049）。复发性感染本身是多变量模型中死亡率的最强预测因素（OR：0.14，95%CI：0.03-0.58；P=0.007）。
NPWT 作为伤口预处理的初始方法，随后进行确定性伤口闭合，可有效降低感染复发率和患者死亡率。在处理心脏手术后复杂切口感染时，它可能成为首选方法。
