Clinical efficacy of multidisciplinary team collaboration in the treatment of deep sternal wound infection

Tong Lin; Lei Chenjia; Zhang Wanfu; Han Fei; Chen Yang; Zhang Hao; Guan Hao

doi:10.3760/cma.j.cn501225-20250402-00159

Volume 41 Issue 11

Nov. 2025

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(11): 1064-1073

Tong L,Lei CJ,Zhang WF,et al.Clinical efficacy of multidisciplinary team collaboration in the treatment of deep sternal wound infection[J].Chin J Burns Wounds,2025,41(11):1064-1073.DOI: 10.3760/cma.j.cn501225-20250402-00159.

Citation:

PDF( 11533 KB)

Clinical efficacy of multidisciplinary team collaboration in the treatment of deep sternal wound infection

doi: 10.3760/cma.j.cn501225-20250402-00159

1.
Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
2.
Outpatient Department of the 5th Xi'an Veteran Cadres Sanatorium, Shaanxi Military Command, Xi'an 710048, China

Funds:

Shaanxi Provincial Health Commission Scientific Research Innovation Capacity Improvement Program 2025PT-03

Air Force Medical University Interdisciplinary Integration Special Funding Project 2024JCO21

More Information

Corresponding author: Guan Hao, Email: guanhao@hotmail.com
Received Date: 2025-04-02

Abstract

Abstract

Objective To evaluate the clinical efficacy of multidisciplinary team (MDT) collaboration in the treatment of deep sternal wound infection (DSWI). Methods This study was a historical controlled trial. According to the diagnosis and treatment model adopted by the patients, 23 DSWI patients who met the selection criteria and were treated in the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University from June 2022 to March 2023 using the traditional single discipline led diagnosis and treatment model were included in non-MDT group, including 13 males and 10 females, aged (56±11) years; 25 DSWI patients who met the inclusion criteria and were treated using MDT diagnosis and treatment model in the unit from April 2023 to May 2024 were included in MDT group, including 12 males and 13 females, aged (54±10) years. For patients in MDT group, after admission, the MDT, composed of chief physicians from 13 departments including burns and cutaneous surgery, cardiothoracic surgery, intensive care medicine, anesthesiology, pharmacy, nutrition, endocrinology, vascular surgery, laboratory medicine, radiology, ultrasound, transfusion, and rehabilitation, jointly evaluated the condition and developed personalized plans for systematic diagnosis and treatment. For patients in non-MDT group, the diagnosis and treatment were led by surgeons from department of burns and cutaneous surgery after admission. When specialist care was limited, consultation with physicians from relevant departments were requested as needed, and a comprehensive plan for diagnosis and treatment was formulated after summarizing the consultation opinions. Once the conditions of patients in both groups stabilized, a thorough debridement of the chest wound was performed, followed by repair surgery with unilateral or bilateral pectoralis major muscle flap or combined rectus abdominis muscle flap. The time from the first surgery for the infected wound to healing, the number of surgeries performed from admission to wound healing, intraoperative blood loss, and operation duration, perioperative complications, wound infection recurrence within 15 d after muscle flap repair surgery, and corresponding incidences of complications and recurrence of wound infection were recorded, and the patient's satisfaction score evaluated using the Patient Satisfaction Scale at discharge. Results The time from the first surgery for the infected wound to healing of patients in MDT group was (12.5±2.8) d, which was significantly shorter than (16.3±2.7) d in non-MDT group (with mean difference of -3.8 d, 95% confidence interval of -5.4 to -2.2 d, t=-4.78, P<0.05). Compared with those in non-MDT group, the number of surgeries performed from admission to wound healing and intraoperative blood loss of patients in MDT group were significantly reduced (Z=-2.54, t=-2.20, P<0.05), and the operation duration was significantly shortened (t=-3.41, P<0.05). During the perioperative period, in MDT group, one patient experienced delayed wound healing, and one patient developed a pulmonary infection; in non-MDT group, two patients experienced delayed wound healing, one patient developed pulmonary infection, and two patients developed deep vein thrombosis in the lower limbs. Wound infection recurrence within 15 d after muscle flap repair surgery occurred in one patient in MDT group and 4 patients in non-MDT group, all of whom healed after dressing change. There were no statistically significant differences in the incidence of perioperative complication or wound infection recurrence within 15 d after muscle flap repair surgery between the two groups of patients (P>0.05). The patient's satisfaction score at discharge in MDT group was 97.7±2.4, which was significantly higher than 95.1±3.5 in non-MDT group (t=3.04, P<0.05). Conclusions For DSWI patients, the MDT diagnosis and treatment model can optimize the treatment plan through joint assessment by physicians from multiple disciplines. It significantly shortens the wound healing time, reduces the number of surgeries and intraoperative blood loss, and improves patient satisfaction without increasing the risk of complications or wound infection recurrence, which is worthy of clinical promotion and application.
- Surgical wound infection,
- Surgical flaps,
- Mediastinitis,
- Sternotomy,
- Multidisciplinary team,
- Wound repair,
- Complication

FullText(HTML)

References(38)

References

[1]	JuhlAA,KoudahlV,DamsgaardTE.Deep sternal wound infection after open heart surgery--reconstructive options[J].Scand Cardiovasc J,2012,46(5):254-261.DOI: 10.3109/14017431.2012.674549.
[2]	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.
[3]	蔡丽娜,李明兄,徐京,等.负压封闭引流联合持续微氧渗透技术在新生儿胸骨切口深部感染中的应用[J].护理学杂志,2023,38(5):25-28.DOI: 10.3870/j.issn.1001-4152.2023.05.025.
[4]	Piwnica-WormsW,AzourySC,KozakG,et al.Flap reconstruction for deep sternal wound infections: factors influencing morbidity and mortality[J].Ann Thorac Surg,2020,109(5):1584-1590.DOI: 10.1016/j.athoracsur.2019.12.014.
[5]	张熠杰,陈刚,官浩,等.胸骨切开术后裂开及组织瓣移植修复研究进展[J].中华烧伤杂志,2019,35(12):879-883.DOI: 10.3760/cma.j.issn.1009-2587.2019.12.010.
[6]	PhoonPHY,HwangNC.Deep sternal wound infection: diagnosis, treatment and prevention[J].J Cardiothorac Vasc Anesth,2020,34(6):1602-1613.DOI: 10.1053/j.jvca.2019.09.019.
[7]	BanjanovicB,KarabdicIH,StrausS,et al.Deep sternal wound infection after open-heart cardiac surgery and vacuum-assisted closure therapy: a single-center study[J]. Med Arch,2022,76(4):273-277.DOI: 10.5455/medarh.2022.76.273-277.
[8]	李汉华,熊兵,刘族安,等.抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果[J].中华烧伤与创面修复杂志,2024,40(5):461-467.DOI: 10.3760/cma.j.cn501225-20231103-00178.
[9]	毛谅,杨翼飞,艾力西尔·艾拜都拉,等.基于多学科诊断与治疗的肝门部胆管癌外科手术疗效和预后影响因素分析[J].中华消化外科杂志,2023,22(7):873-883.DOI: 10.3760/cma.j.cn115610-20230509-00200.
[10]	李梦伊,张鹏,张忠涛.推动减重与代谢外科高质量发展的临床科研与多学科协作[J].中华消化外科杂志,2025,24(8):992-996. DOI: 10.3760/cma.j.cn115610-20250624-00448.
[11]	KhashkhushaA,ButtS,AbdelghaffarM,et al.Sternal wound reconstruction following deep sternal wound infection: past, present and future: a literature review[J].J Cardiovasc Dev Dis,2024,11(11):361.DOI: 10.3390/jcdd11110361.
[12]	StreckerT,RöschJ,HorchRE,et al.Sternal wound infections following cardiac surgery: risk factor analysis and interdisciplinary treatment[J].Heart Surg Forum,2007,10(5):E366-371.DOI: 10.1532/HSF98.20071079.
[13]	van WingerdenJJ,UbbinkDT,van der HorstCM,et al.Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review[J].J Cardiothorac Surg,2014,9:179.DOI: 10.1186/s13019-014-0179-4.
[14]	SongY,ChuW,SunJ,et al.Review on risk factors, classification, and treatment of sternal wound infection[J].J Cardiothorac Surg,2023,18(1):184.DOI: 10.1186/s13019-023-02228-y.
[15]	HoranTC,AndrusM,DudeckMA.CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J].Am J Infect Control,2008,36(5):309-332.DOI: 10.1016/j.ajic.2008.03.002.
[16]	王静,杨阳.基于多学科协作的胸痛预警护理培训模式在临床带教中的应用[J].护理研究,2023,37(3):535-538.DOI: 10.12102/j.issn.1009-6493.2023.03.029.
[17]	柯菊青,朱迪,杨忠青,等.多学科协作下急诊主动脉夹层患者院际转运方案的构建及应用[J].护理管理杂志,2025,25(3):185-191.DOI: 10.3969/j.issn.1671-315x.2025.03.001.
[18]	张佳佳,封燕飞,赵宇,等.多学科团队快速绿色通道流程在严重多发伤患者急救中的应用[J].中国急救复苏与灾害医学杂志,2025,20(6):742-745,763.DOI: 10.3969/j.issn.1673-6966.2025.06.010.
[19]	LeeDY,EoS,LimS,et al.Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review[J].Front Surg,2023,10:1268555.DOI: 10.3389/fsurg.2023.1268555.
[20]	佟琳,胡晓龙,张万福,等.腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果[J].中华烧伤杂志,2021,37(11):1048-1053.DOI: 10.3760/cma.j.cn501120-20210204-00050.
[21]	杨姣,王玲,张万福,等.盔甲式胸带在胸骨裂开患者修复术后的应用效果[J].中华烧伤与创面修复杂志,2024,40(4):358-364.DOI: 10.3760/cma.j.cn501225-20230904-00074.
[22]	张万福,徐婧,张敬群,等.胸骨切开术后继发伴胸骨骨髓炎和/或纵隔炎创面的围手术期处理及其临床效果[J].中华烧伤与创面修复杂志,2024,40(2):151-158.DOI: 10.3760/cma.j.cn501225-20231028-00141.
[23]	吴天一,吴承霖,陈亦轩,等.多学科诊疗加速康复外科模式在老年骨质疏松性踝关节骨折治疗中的应用[J].中华创伤骨科杂志,2025,27(1):57-63.DOI: 10.3760/cma.j.cn115530-20241030-00424.
[24]	AroojS.Emerging role of radiologist in multidisciplinary team meetings[J].Pak J Med Sci,2023,39(4):919-920.DOI: 10.12669/pjms.39.4.7645.
[25]	ZhangQ,ZhouY,SongL,et al.China special issue on gastrointestinal tumors-improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: a multicenter, noninterventional, controlled study[J].Int J Cancer,2023,153(11):1885-1893.DOI: 10.1002/ijc.34543.
[26]	ZengY,ZhuS,WangZ,et al.Multidisciplinary team (MDT) discussion improves overall survival outcomes for metastatic renal cell carcinoma patients[J].J Multidiscip Healthc,2023,16:503-513.DOI: 10.2147/JMDH.S393457.
[27]	LangitMB,TayKS,Al-OmarHK,et al.Surgical debridement in long bone chronic osteomyelitis: is wide tumour-like resection necessary?[J].Bone Jt Open,2023,4(8):643-651.DOI: 10.1302/2633-1462.48.BJO-2023-0017.R1.
[28]	WangFD,ChangCH.Risk factors of deep sternal wound infections in coronary artery bypass graft surgery[J].J Cardiovasc Surg (Torino),2000,41(5):709-713.
[29]	DowningM,ModrowM,Thompson-BrazillKA,et al.Eliminating sternal wound infections: why every cardiac surgery program needs an I hate infections team[J].JTCVS Tech,2023,19:93-103.DOI: 10.1016/j.xjtc.2023.03.019.
[30]	BiancoV,KilicA,Aranda-MichelE,et al.Thirty-day hospital readmissions following cardiac surgery are associated with mortality and subsequent readmission[J].Semin Thorac Cardiovasc Surg,2021,33(4):1027-1034.DOI: 10.1053/j.semtcvs.2020.12.015.
[31]	陈丽丽,金玲玲,徐海霞.心脏外科术后患者深部胸骨切口感染临床及流行病学特征[J].中华医院感染学杂志,2024,34(11):1683-1686.DOI: 10.11816/cn.ni.2024-231506.
[32]	Abu-OmarY,KocherGJ,BoscoP,et al.European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis[J].Eur J Cardiothorac Surg,2017,51(1):10-29.DOI: 10.1093/ejcts/ezw326.
[33]	LazarHL,SalmTV,EngelmanR,et al.Prevention and management of sternal wound infections[J].J Thorac Cardiovasc Surg,2016,152(4):962-972.DOI: 10.1016/j.jtcvs.2016.01.060.
[34]	NilssonU,GruenR,MylesPS.Postoperative recovery: the importance of the team[J].Anaesthesia,2020,75Suppl 1:e158-e164.DOI: 10.1111/anae.14869.
[35]	VernooijJ,BoerlageRM,DoggenCJM,et al.Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study-a multicenter stepped-wedge cluster randomized trial[J].Trials,2023,24(1):660.DOI: 10.1186/s13063-023-07685-3.
[36]	StaudtMD.The multidisciplinary team in pain management[J].Neurosurg Clin N Am,2022,33(3):241-249.DOI: 10.1016/j.nec.2022.02.002.
[37]	Le ThanhV,BellR,SymonsN,et al.The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion[J].Clin Case Rep,2023,11(9):e7689.DOI: 10.1002/ccr3.7689.
[38]	TranTH,de BoerJ,GyorkiDE,et al.Optimising the quality of multidisciplinary team meetings: a narrative review[J].Cancer Med,2022,11(9):1965-1971.DOI: 10.1002/cam4.4432.