Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

Li Hanhua; Xiong Bing; Liu Zu'an; Huang Zhifeng; Sun Chuanwei; Luo Hongmin; Ma Lianghua; Bian Huining; Zheng Shaoyi; Lai Wen

doi:10.3760/cma.j.cn501225-20231103-00178

Volume 40 Issue 5

May 2024

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(5): 461-467

Li Feifei, Zhang Jie, Gao Chunchen, et al. Influence of maggot excretions/secretions on the anti-Pseudomonas aeruginosa effect of neutrophils in patients with diabetic foot ulcer[J]. Chin j Burns, 2021, 37(5): 413-419. DOI: 10.3760/cma.j.cn501120-20210312-00085

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Li HH,Xiong B,Liu ZA,et al.Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy[J].Chin J Burns Wounds,2024,40(5):461-467.DOI: 10.3760/cma.j.cn501225-20231103-00178.

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Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

doi: 10.3760/cma.j.cn501225-20231103-00178

1.
Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
2.
Department of Burns and Wound Repair Surgery, Burns and Wound Repair Institute, Shenzhen People's Hospital, Shenzhen 518000, China

Funds:

Key Project of Guangdong Basic and Applied Basic Research Foundation 2020B1515120088

Basic and Applied Research of Science and Technology Project of Guangzhou 202102080323

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Corresponding author: Lai Wen, Email: Laiwencn@msn.com
Received Date: 2023-11-03

Abstract

Abstract

Objective To investigate the effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy. Methods This study was a retrospective non-randomized clinical controlled study. A total of 32 patients (20 males and 12 females, aged (58±11) years) who met the inclusion criteria and underwent closure with antibacterial absorbable sutures (hereinafter referred to as direct closure surgery) admitted to Guangdong Provincial People's Hospital of Southern Medical University (hereinafter referred to as our hospital) from October 2017 to December 2021 were included in direct closure group. A total of 39 patients (27 males and 12 females, aged (59±11) years) who met the inclusion criteria and received bilateral pectoralis major muscle flap packing repair admitted to our hospital from January 2015 to January 2020, were included in muscle flap packing group. In the two groups, sternal infected wounds were thoroughly debrided during stage Ⅰ surgery, followed by wound repair during stage Ⅱ surgery. The width of sternal cross-section defects after debridement was less than 1 cm for patients in the two groups. For patients in direct closure group, stage Ⅱ wound repair involved intermittent sutures to the anterior sternal plate or full-thickness sternum with a total of 6 or 7 double sternal sutures. Relevant data including the duration of the stage Ⅱ wound repair surgery and the volume of blood loss during surgery, length of hospital stay, and bacterial wound infection of patients in the two groups were recorded. The postoperative complications and wound healing of patients in the two groups were recorded. During follow-up, the wound infection or recurrence of patients in the two groups and the sternal healing of patients in direct closure group were observed. Results Compared with those in muscle flap packing group, the duration of stage Ⅱ wound repair surgery and length of hospital stay of patients in direct closure group were significantly shorter (with t values of 13.61 and 6.25, respectively, P<0.05), and there was no statistically significant difference in intraoperative blood loss volume of the stage Ⅱ wound repair surgery between the two groups (P>0.05). The main bacterial infection in the two groups was Staphylococcus. In direct closure group, one patient had exudation in the wound two weeks post-operation, however the wound healed well after two weeks of conservative dressing changes; the wounds of the other patients healed well. In muscle flap packing group, 5 patients had postoperative complications, of which one patient died, and the wounds of 4 patients healed after dressing change or reoperation; the wounds of the other patients healed well. There was no statistically significant difference in complication incidence of patients between the two groups (P>0.05). During the follow-up of 22-45 months, there was no re-infection or recurrence in the wound of patients in direct closure group and surviving patients in muscle flap packing group, the sternum of patients in the direct closure group achieved anatomical union. Conclusions Direct closure surgery can not only effectively repair sternal cross-sectional defects with width below 1 cm due to deep sternal wound infections after median thoracotomy, but can also significantly shorten the operation time and duration of hospitalization.
- Debridement,
- Sternotomy,
- Surgical wound infection,
- Anti-microbial absorbable suture closure,
- Bone defect,
- Wound repair

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[1]	官浩, 陈阳. 重视胸骨切开术后胸骨深部伤口感染的预防和处理[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 125-130. DOI: 10.3760/cma.j.cn501225-20231212-00235.
[2]	ZukowskaA, ZukowskiM. Surgical site infection in cardiac surgery[J]. J Clin Med, 2022,11(23):6991. DOI: 10.3390/jcm11236991.
[3]	Perezgrovas-OlariaR, AudisioK, CancelliG, et al. Deep sternal wound infection and mortality in cardiac surgery: a meta-analysis[J]. Ann Thorac Surg, 2023,115(1):272-280. DOI: 10.1016/j.athoracsur.2022.04.054.
[4]	FinkelsteinR, RabinoG, MashiahT, et al. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program[J]. Am J Infect Control, 2005,33(8):450-454. DOI: 10.1016/j.ajic.2005.07.002.
[5]	OlsenMA, Lock-BuckleyP, HopkinsD, et al. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different[J]. J Thorac Cardiovasc Surg, 2002,124(1):136-145. DOI: 10.1067/mtc.2002.122306.
[6]	LuJC, GraysonAD, JhaP, et al. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery[J]. Eur J Cardiothorac Surg, 2003,23(6):943-949. DOI: 10.1016/s1010-7940(03)00137-4.
[7]	SchimmerC, ReentsW, BernederS, et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial[J]. Ann Thorac Surg, 2008,86(6):1897-1904. DOI: 10.1016/j.athoracsur.2008.08.071.
[8]	SinghK, AndersonE, HarperJG. Overview and management of sternal wound infection[J]. Semin Plast Surg, 2011,25(1):25-33. DOI: 10.1055/s-0031-1275168.
[9]	KaspersenAE, NielsenSJ, OrrasonAW, et al. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART[J]. Eur J Cardiothorac Surg, 2021,60(2):233-241. DOI: 10.1093/ejcts/ezab080.
[10]	SamoukovicG, BernierPL, LachapelleK. Successful treatment of infected ascending aortic prosthesis by omental wrapping without graft removal[J]. Ann Thorac Surg, 2008,86(1):287-289. DOI: 10.1016/j.athoracsur.2008.01.086.
[11]	郑少逸, 赖文, 黄志锋, 等. 双侧胸大肌肌瓣治疗开胸术后胸骨骨髓炎临床效果[J].中华烧伤杂志,2015,31(1):61-63. DOI: 10.3760/cma.j.issn.1009-2587.2015.01.016.
[12]	BrownRH, SharabiSE, KaniaKE, et al. The split pectoralis flap: combining the benefits of pectoralis major advancement and turnover techniques in one flap[J]. Plast Reconstr Surg, 2017,139(6):1474-1477. DOI: 10.1097/PRS.0000000000003328.
[13]	SpartalisE, MarkakisC, MorisD, et al. Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection[J]. Surg Today, 2016,46(4):460-465. DOI: 10.1007/s00595-015-1192-5.
[14]	KamelGN, JacobsonJ, RizzoAM, et al. Analysis of immediate versus delayed sternal reconstruction with pectoralis major advancement versus turnover muscle flaps[J]. J Reconstr Microsurg, 2019,35(8):602-608. DOI: 10.1055/s-0039-1688760.
[15]	BotaO, JostenC, BorgerMA, et al. Standardized musculocutaneous flap for the coverage of deep sternal wounds after cardiac surgery[J]. Ann Thorac Surg, 2019,107(3):802-808. DOI: 10.1016/j.athoracsur.2018.09.017.
[16]	DavisonSP, ClemensMW, ArmstrongD, et al. Sternotomy wounds: rectus flap versus modified pectoral reconstruction[J]. Plast Reconstr Surg, 2007,120(4):929-934. DOI: 10.1097/01.prs.0000253443.09780.0f.
[17]	GeorgiouI, IoannouCI, SchmidtJ, et al. Free flaps in sternal osteomyelitis after median sternotomy: a center's 12-year experience[J]. J Reconstr Microsurg, 2023,39(8):601-615. DOI: 10.1055/s-0043-1761208.
[18]	MarzoukM, BaillotR, KalavrouziotisD, et al. Early to midterm survival of patients with deep sternal wound infection managed with laparoscopically harvested omentum[J]. J Card Surg, 2021,36(11):4083-4089. DOI: 10.1111/jocs.15955.
[19]	Lo TortoF, TurrizianiG, DonatoC, et al. Deep sternal wound infection following cardiac surgery: a comparison of the monolateral with the bilateral pectoralis major flaps[J]. Int Wound J, 2020,17(3):683-691. DOI: 10.1111/iwj.13324.
[20]	EpsteinAE, AlexanderJC, GuttermanDD, et al. Anticoagulation: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery[J]. Chest, 2005,128(2 Suppl):24S-27S. DOI: 10.1378/chest.128.2_suppl.24s.
[21]	LiòP, PaolettiN, MoniMA, et al. Modelling osteomyelitis[J]. BMC Bioinformatics, 2012,14(Suppl 14):S12. DOI: 10.1186/1471-2105-13-S14-S12.
[22]	Gómez-AlonsoA, García-CriadoFJ, Parreño-ManchadoFC, et al. Study of the efficacy of Coated VICRYL Plus Antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery[J]. J Infect, 2007,54(1):82-88. DOI: 10.1016/j.jinf.2006.01.008.
[23]	AbiriA, PaydarO, TaoA, et al. Tensile strength and failure load of sutures for robotic surgery[J]. Surg Endosc, 2017,31(8):3258-3270. DOI: 10.1007/s00464-016-5356-1.
[24]	GrossiEA, CullifordAT, KriegerKH, et al. A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures[J]. Ann Thorac Surg, 1985,40(3):214-223. DOI: 10.1016/s0003-4975(10)60030-6.
[25]	郑少逸, 陈华德, 孙传伟, 等. 开胸术后胸部正中难愈性伤口的临床分级及治疗[J].中国修复重建外科杂志,2014,28(9):1120-1124. DOI: 10.7507/1002-1892.20140244.

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Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

doi: 10.3760/cma.j.cn501225-20231103-00178

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Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

doi: 10.3760/cma.j.cn501225-20231103-00178

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