Saltarocchi Sara, Chourda Emmanouela, D'Abramo Mizar, Saade Wael, Miraldi Fabio
Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy.
Wounds. 2023 Feb;35(2):E63-E68. doi: 10.25270/wnds/21141.
DSWI, or mediastinitis, is a life-threatening complication following cardiac surgery. Although infrequent, it can cause significant morbidity and mortality, often requires multiple procedures, and increases health care costs. Different treatment approaches have been used.
This article compares closed catheter irrigation with the currently used 2-stage approach using a proprietary vacuum-assisted wound closure with instillation system followed by sternal synthesis with nitinol clips.
The records of 34 patients with DSWI who underwent cardiac surgery between January 2012 and December 2020 were retrospectively analyzed. Patients received either closed catheter irrigation or vacuum-assisted wound closure with instillation for decontamination and subsequent closure with pectoralis major flaps (with or without the modified Robicsek technique), or more recently, with nitinol clips.
Wound healing was achieved in all patients treated with vacuum-assisted wound closure with instillation. In this group, no patients died and the mean hospital stay was reduced.
These findings suggest that use of vacuum-assisted wound closure with instillation along with nitinol clips for sternal closure decreases mortality and reduces the length of hospital stay, making it a safer, effective, and less invasive technique for the management of DSWI after cardiac surgery.
深部胸骨伤口感染（DSWI），即纵隔炎，是心脏手术后一种危及生命的并发症。尽管并不常见，但它可导致严重的发病和死亡，常需多次手术，并增加医疗费用。人们采用了不同的治疗方法。
本文比较了闭式导管冲洗与目前使用的两阶段方法，后者采用一种专有的负压辅助伤口闭合与滴注系统，随后用镍钛合金夹子进行胸骨固定。
回顾性分析了2012年1月至2020年12月期间34例接受心脏手术并发生DSWI的患者的病历。患者接受了闭式导管冲洗或负压辅助伤口闭合与滴注以进行清创，随后用胸大肌瓣（采用或不采用改良的罗比克塞克技术），或最近用镍钛合金夹子进行闭合。
所有接受负压辅助伤口闭合与滴注治疗的患者伤口均愈合。在该组中，无患者死亡，平均住院时间缩短。
这些发现表明，使用负压辅助伤口闭合与滴注并结合镍钛合金夹子进行胸骨闭合可降低死亡率并缩短住院时间，使其成为心脏手术后DSWI管理中一种更安全、有效且侵入性更小的技术。
