Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery.
OBJECTIVE
We sought to compare clinical outcomes, in-hospital mortality and 1-year survival of two different treatment modalities of deep sternal wound infection, topical negative pressure and the closed irrigation therapy.


METHODS
Retrospective analysis of 66 consecutive patients treated for deep sternal infection at our institution. A total of 28 patients (February 2002 through September 2004) underwent primarily closed irrigation therapy, and 34 patients (November 2004 through December 2007) had the application of topical negative pressure. Four patients (July 2004 through December 2004) who underwent a combination of both strategies were excluded from the study. Clinical and wound care outcomes were compared, focusing on therapeutic failure rate, in-hospital stay and the 1-year mortality of both treatment strategies.


RESULTS
Topical negative pressure was associated with a significantly lower failure rate of the primary therapy (P<0.05), shortening of the intensive care unit stay (P<0.001), a particular decrease in the in-hospital stay (P<0.05) and the 1-year mortality (P<0.05) in comparison with closed irrigation therapy. Comparable overall length of the therapy, in-hospital stay and the risk of wire-related fistulas after chest reconstruction were found.


CONCLUSIONS
Topical negative pressure is a superior method of treatment for deep sternal wound infection, which is based on lower therapeutic failure rate, significant decrease in-hospital stay, and the decrease of the 1-year mortality rate, compared with primarily applied closed irrigation.
Department of Cardiac Surgery, University Hospital and Palacky University, Faculty of Medicine, Olomouc, Czech Republic. martin.simek@c-mail.cz
M
M
Simek
R
R
Hajek
I
I
Fluger
M
M
Molitor
J
J
Grulichova
K
K
Langova
P
P
Tobbia
P
P
Nemec
B
B
Zalesak
V
V
Lonsky
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects; D013249:Sternum; D013530:Surgical Wound Infection / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology; D007507:Therapeutic Irrigation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing