Li Tse-Hsi, Lin Cheng-Hsin, Peng Chung-Kan, Wu Yi-Chun, Hsieh Tsung-Cheng, Lee Chi-Hung, Liu Yung-Ching, Huang Kun-Lun, Tam Ka-Wai, Chang Shun-Cheng
Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Taiwan.
Department of Surgery, Shuang Ho Hospital, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
J Wound Care. 2025 Jan 2;34(1):48-58. doi: 10.12968/jowc.2022.0095.
Deep sternal wound infection (DSWI) is a rare but devastating complication that is estimated to occur in 1-2% of patients after median sternotomy. Current standard of care (SoC) comprises antibiotics, debridement and negative pressure wound therapy (NPWT). Hyperbaric oxygen therapy (HBOT) appears to be an effective adjuvant therapy for osteomyelitis. The aim of this study was to determine the effectiveness of HBOT and real-time fluorescence imaging (RTFI) in a DSWI treatment protocol and their benefits on infection control.
A retrospective analysis of DSWI management was performed. Enrolled patients were divided into two groups: HBOT group and RTFI group. Patients in the HBOT group received SoC, HBOT, NPWT and reconstructive flap surgery. Patients in the RTFI group received the same therapeutic plan as well as treatment with a RTFI device (MolecuLight i:X (MolecuLight, Inc., Canada) to achieve high-quality debridement. Infection status and short-term outcomes within three months were measured. Long-term outcomes were analysed at a 12-month follow-up.
Of the 55 patients enrolled: 22 in the HBOT group and 33 in the RTFI group. Infection control status, evaluated in terms of white blood cell counts and C-reactive protein levels, antibiotic use duration, antibiotic costs, reinfection rate and osteomyelitis recurrence rate, were statistically significantly improved in the RTFI group (<0.001, <0.001, 0.042, 0.022, 0.049 and 0.022, respectively). Length of total intensive care unit stay and duration of complete healing were statistically significantly decreased in the RTFI group (<0.001 and 0.046, respectively).
Patients with DSWI can benefit from HBOT, especially in terms of in-hospital mortality. RTFI can be used to eliminate bacterial burden and achieve high-quality debridement, which considerably improves infection control and clinical outcomes.
深部胸骨伤口感染（DSWI）是一种罕见但具有毁灭性的并发症，据估计在正中胸骨切开术后1%-2%的患者中会发生。当前的标准治疗（SoC）包括使用抗生素、清创术和负压伤口治疗（NPWT）。高压氧治疗（HBOT）似乎是治疗骨髓炎的一种有效辅助疗法。本研究的目的是确定HBOT和实时荧光成像（RTFI）在DSWI治疗方案中的有效性及其对感染控制的益处。
对DSWI管理进行回顾性分析。纳入的患者分为两组：HBOT组和RTFI组。HBOT组患者接受SoC、HBOT、NPWT和重建皮瓣手术。RTFI组患者接受相同的治疗方案以及使用RTFI设备（MolecuLight i:X（加拿大MolecuLight公司））进行治疗以实现高质量清创。测量三个月内的感染状况和短期结局。在12个月随访时分析长期结局。
纳入的55例患者中：HBOT组22例，RTFI组33例。在控制感染状况方面，根据白细胞计数和C反应蛋白水平、抗生素使用时长、抗生素费用、再感染率和骨髓炎复发率评估，RTFI组有统计学显著改善（分别为<0.001、<0.001、0.042、0.022、0.049和0.022）。RTFI组的总重症监护病房住院时长和完全愈合时长有统计学显著缩短（分别为<0.001和0.046）。
DSWI患者可从HBOT中获益，尤其是在医院死亡率方面。RTFI可用于消除细菌负荷并实现高质量清创，这可显著改善感染控制和临床结局。
