title: Ultrasound-assisted treatment of sternocutaneous fistula in post-sternotomy cardiac surgery patients.
abstract: OBJECTIVE
  Using an ultrasonic debridement system (low frequency, 25 kHz), we aimed to completely remove bacterial biofilms and preserve vital sternal tissue and to compare this procedure with conventional surgical therapy.
  
  
  METHODS
  In this retrospective study, we evaluated 37 consecutive patients (25 males) between April 2011 and June 2013 in whom sternocutaneous fistula (SCF) was treated with the ultrasound-assisted wound (UAW) system (Group A, n = 18) or with conventional surgical therapy (Group B, n = 19). Treatment in Group A consisted of a complete dissection of the SCF followed by a multistep UAW debridement session after an interval of 3 days. Our final step in both groups was secondary wound closure with a musculocutaneous flap.
  
  
  RESULTS
  Patients in both groups were categorized as high risk with respect to several of the known SCF risk factors. In both groups, a similar variety of bacteria were isolated: 61% were gram-positive species, 16.5% were gram-negative species and 10.5% were Candida albicans. Time to secondary wound closure following eradication was significantly shorter in Group A (10 ± 5.4 vs 15 ± 7.1 days in Group B, P = 0.012). Postoperative antibiotic treatment time (16 ± 9.3 vs 22 ± 10.7 days in Group B, P = 0.078) showed a trend in favour of Group A, but the mean hospitalization time (22 ± 12.0 vs 26 ± 14.3 days in Group B, P = 0.34) did not differ between groups. Recurrence of SCF tended to be less frequent in Group A (6 vs 21% in Group B, P = 0.46). In Group B, one infection-related death was noted. The mean follow-up time was 8 ± 2.7 (Group A) and 10 ± 5.7 (Group B) months.
  
  
  CONCLUSIONS
  Ultrasonic debridement is a promising adjunct to SCF treatment. In combination with adequate surgical and antimicrobial therapy, we documented good mid-term results in our trial group.
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany ltewarie@ukaachen.de.
authors: Lachmandath
authors: L
authors: Tewarie
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
authors: Ajay Kumar
authors: AK
authors: Moza
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
authors: Rashad
authors: R
authors: Zayat
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
authors: Rüdiger
authors: R
authors: Autschbach
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
authors: Andreas
authors: A
authors: Goetzenich
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany.
authors: Ares Krishna
authors: AK
authors: Menon
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum; D059708:Ultrasonic Surgical Procedures / Q000379:methods*; D014463:Ultrasonography
keywords: Cardiac surgery; Sternocutaneous fistula; Ultrasonic debridement