Abstract

Introduction. Negative pressure wound therapy (NPWT) has widely become the first-line option in the treatment of deep sternal wound infections. After several positive reports in comparison with conventional treatment, very recent studies comparing NPWT with early reconstruction have favored the latter. Our aim was to evaluate the effectiveness and safety of NPWT in comparison with early flap reconstruction. Materials and methods. We concluded a retrospective analysis of 125 patients with deep sternal wound infection treated in a single institution between the years 2006 and 2018. NPWT became the first-line treatment in our hospital in 2011. The study group consisted of 55 patients treated primarily with NPWT with or without subsequent flap reconstruction. The control group consisted of 60 patients treated with flap reconstruction without prior NPWT. Ten patients with an immediate re-fixation and direct wound closure were excluded. Results. There were no significant differences between the two groups concerning the type or urgency of the original open-heart surgery, age, gender, or co-morbidities. In the NPWT group there was significantly higher mortality (p = .002), longer stay in the intensive care unit (p = .028), and in the university hospital (p < .001) as well as higher number of operations (p < .001). However, there were somewhat more surgical complications in the control group as well as a higher number of distant flap reconstructions. Overall, five patients suffered from NPWT associated bleeding. Conclusion. Our results raise concerns about the wide use of NPWT as a first-line treatment of deep sternal wound infections. Further evaluative studies are warranted to confirm the results.

摘要

简介。负压伤口治疗（NPWT）已广泛成为治疗胸骨深部伤口感染的一线选择。在与常规治疗相比的几个积极报告之后，最近比较 NPWT 与早期重建的研究有利于后者。我们的目的是评估 NPWT 与早期皮瓣重建相比的有效性和安全性。材料和方法. 我们总结了 2006 年至 2018 年间在单一机构治疗的 125 例胸骨深部伤口感染患者的回顾性分析。NPWT 于 2011 年成为我院的一线治疗方法。研究组由 55 名主要接受 NPWT 治疗的患者组成。或没有后续的皮瓣重建。对照组由 60 名接受皮瓣重建治疗的患者组成，之前没有 NPWT。排除了 10 名立即重新固定和直接伤口闭合的患者。结果。两组在原始心脏直视手术的类型或紧迫性、年龄、性别或合并症方面没有显着差异。在 NPWT 组中，死亡率显着更高（p  = .002），在重症监护病房的停留时间更长（p  = .028)，在大学医院 ( p  < .001) 以及更高的手术次数 ( p  < .001)。然而，对照组的手术并发症有所增加，远端皮瓣重建的数量也更多。总体而言，有 5 名患者患有 NPWT 相关出血。结论。我们的结果引起了人们对广泛使用 NPWT 作为深部胸骨伤口感染的一线治疗的担忧。需要进一步的评估研究来确认结果。