Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series

Journal of Cardiothoracic Surgery

Terry C. Stelly³  Charles B. Rodning²  Meghan M. Stelly¹ 

[1] Clemson University, Clemson, South Carolina, USA;Department of Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA;Cardiothoracic and Vascular Surgical Associates, 1855 Springhill Avenue, Mobile 36607, Alabama, USA

关键词: Surgical equipment;    Devices;    Surgery;    Sternum;    Infection;    Sternum;   

Others  :  1234595
DOI  :  10.1186/s13019-015-0378-7

 received in 2015-10-12, accepted in 2015-11-08,  发布年份 2015

【 摘 要 】

Background

Deep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.

Methods

In this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.

Results

Between July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m ²wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).

Conclusions

The peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.

【 授权许可】

   
2015 Stelly et al.

【 图 表 】

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【 参考文献 】

• [1]McGregor WE, Trumble DR, Magovern JA. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg. 1999; 117:1144-1150.
• [2]Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M et al.. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg. 1990; 49:179-186.
• [3]Eklund AM, Lyytikainen O, Klemets P, Huotari K, Anttila VJ, Werkkala KA et al.. Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg. 2006; 82:1784-1789.
• [4]Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg. 2002; 21:825-830.
• [5]Lu JC, Grayson AD, Jha P, Srinivasan AK, Fabri BM. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2003; 23:943-949.
• [6]Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation. 1995; 92:2245-2251.
• [7]Raudat CW, Pagel J, Woodhall D, Wojtanowski M, Van Bergen R. Early intervention and aggressive management of infected median sternotomy incision: a review of 2242 open-heart procedures. Am Surg. 1997; 63:238-241.
• [8]Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg. 2000; 17:482-484.
• [9]Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE et al.. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998; 65:1050-1056.
• [10]Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004; 38:1706-1715.
• [11]Braxton JH, Marrin CA, McGrath PD, Morton JR, Norotsky M, Charlesworth DC et al.. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg. 2004; 16:70-76.
• [12]Guvener M, Pasaoglu I, Demircin M, Oc M. Perioperative hyperglycemia is a strong correlate of postoperative infection in type II diabetic patients after coronary artery bypass grafting. Endocr J. 2002; 49:531-537.
• [13]Lipshutz AK, Gropper MA. Perioperative glycemic control: an evidence-based review. Anesthesiology. 2009; 110:408-421.
• [14]Ottino G, De Paulis R, Pansini S, Rocca G, Tallone MV, Comoglio C et al.. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg. 1987; 44:173-179.
• [15]Toumpoulis IK, Theakos N, Dunning J. Does bilateral internal thoracic artery harvest increase the risk of mediastinitis? Interact Cardiovasc Thorac Surg. 2007; 6:787-791.
• [16]Johnston RHJ, Garcia-Rinaldi R, Vaughan GD, Bricker D. Mersilene ribbon closure of the median sternotomy: an improvement over wire closure. Ann Thorac Surg. 1985; 39:88-89.
• [17]Kalush SL, Bonchek LI. Peristernal closure of median sternotomy using stainless steel bands. Ann Thorac Surg. 1976; 21:172-173.
• [18]Sirivella S, Zikria EA, Ford WB, Samadani SR, Miller WH, Sullivan ME. Improved technique for closure of median sternotomy incision. Mersilene tapes versus standard wire closure. J Thorac Cardiovasc Surg. 1987; 94:591-595.
• [19]Soroff HS, Hartman AR, Pak E, Sasvary DH, Pollak SB. Improved sternal closure using steel bands: early experience with three-year follow-up. Ann Thorac Surg. 1996; 61:1172-1176.
• [20]Kluytmans JA, Mouton JW, VandenBergh MF, Manders MJ, Maat AP, Wagenvoort JH et al.. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol. 1996; 17:780-785.
• [21]Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999; 27:97-132.
• [22]Nicholson MR, Huesman LA. Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients. Am J Infect Control. 2006; 34:44-48.
• [23]Bitkover CY, Gardlund B. Mediastinitis after cardiovascular operations: a case–control study of risk factors. Ann Thorac Surg. 1998; 65:36-40.
• [24]Serry C, Bleck PC, Javid H, Hunter JA, Goldin MD, DeLaria GA et al.. Sternal wound complications. Management and results. J Thorac Cardiovasc Surg. 1980; 80:861-867.
• [25]Stoney WS, Alford WCJ, Burrus GR, Frist RA, Thomas CSJ. Median sternotomy dehiscence. Ann Thorac Surg. 1978; 26:421-426.
• [26]Sargent LA, Seyfer AE, Hollinger J, Hinson RM, Graeber GM. The healing sternum: a comparison of osseous healing with wire versus rigid fixation. Ann Thorac Surg. 1991; 52:490-494.
• [27]Raman J, Lehmann S, Zehr K, De Guzman BJ, Aklog L, Garrett HE et al.. Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial. Ann Thorac Surg. 2012; 94:1854-1861.
• [28]Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg. 1999; 15:365-369.
• [29]McGregor WE, Payne M, Trumble DR, Farkas KM, Magovern JA. Improvement of sternal closure stability with reinforced steel wires. Ann Thorac Surg. 2003; 76:1631-1634.
• [30]LeVeen HL, Piccone VA. Nylon-band chest closure. Arch Surg. 1968; 96:36-39.
• [31]Sanfelippo PM, Danielson GK. Nylon bands for closure of median sternotomy incisions: an unacceptable method. Ann Thorac Surg. 1972; 13:404-406.
• [32]Grapow MT, Melly LF, Eckstein FS, Reuthebuch OT. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation. J Cardiothorac Surg. 2012; 7:59. BioMed Central Full Text
• [33]Melly L, Gahl B, Meinke R, Rueter F, Matt P, Reuthebuch O et al.. A new cable-tie-based sternal closure device: infectious considerations. Interact Cardiovasc Thorac Surg. 2013; 17(2):219-223.
• [34]Conolly WB, Hunt TK, Sonne M, Dunphy JE. Influence of distant trauma on local wound infection. Surg Gynecol Obstet. 1969; 128:713-718.
• [35]Kawai K, Kageyama A, Tsumano T, Nishimoto S, Fukuda K, Yokoyama S et al.. Effects of adiponectin on growth and differentiation of human keratinocytes--implication of impaired wound healing in diabetes. Biochem Biophys Res Commun. 2008; 374:269-273.
• [36]Pierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC et al.. Obesity and surgical wound healing: a current review. ISRN Obes. 2014; 2014:638936.
• [37]Shibata R, Ouchi N, Kihara S, Sato K, Funahashi T, Walsh K. Adiponectin stimulates angiogenesis in response to tissue ischemia through stimulation of amp-activated protein kinase signaling. J Biol Chem. 2004; 279:28670-28674.
• [38]Shipman AR, Millington GW. Obesity and the skin. Br J Dermatol. 2011; 165:743-750.