Skip to main content

Advertisement

SpringerLink
Log in

Negative-pressure sternal wound closure with interrupted subcuticular suturing and a subcutaneous drain tube reduces the incidence of poststernotomy wound infection after coronary artery bypass grafting surgery

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purposes

To retrospectively evaluate the effect of negative-pressure sternal wound closure (NPSWC) with a subcutaneous closed drain tube on the sternal surgical site infection (SSI) incidence.

Methods

After propensity score matching of 231 patients undergoing coronary artery bypass grafting (CABG), we compared 104 pairs in the NPSWC and historical control groups. In the molecular analysis, the interleukin-6 (IL-6), basic fibroblast growth factor (b-FGF), and transforming growth factor β1 (TGF-β1) levels in the wound fluid were measured using two different reservoir types at postoperative days 2 and 7.

Results

NPSWC significantly reduced the SSI incidence from 10.6 to 2.9%. No mediastinitis occurred in the NPSWC group. A multivariate logistic regression analysis identified female sex (p = 0.0040) and no NPSWC (p = 0.0084) as significant risk factors for sternal SSI development. The Negative-pressure value was 49.4 ± 4.1 and 115.5 ± 15.2 mmHg in the standard-type (SSR) and bulb-type suction reservoirs (BSR), respectively. Given that growth factors were affected by the difference in negative pressure, the IL-6, b-FGF, and TGF-β1 levels were significantly higher in the BSR than in the SSR.

Conclusions

NPSWC using a subcutaneous closed drain tube was effective in preventing sternal SSI after CABG and may accelerate wound healing even when both internal thoracic arteries are harvested.

Clinical registration number

University Hospital Medical Information Network Clinical Trials Registry, registration number: UMIN000037060.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M, et al. Sternal wound complication after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann Thorac Surg. 1990;49:179–87.

    Article  CAS  Google Scholar 

  2. Findeisen A, Arefian H, Doenst T, Hagel S, Pletz MW, Hartmann M, et al. Economic burden of surgical site infections in patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2019;55:494–500.

    Article  Google Scholar 

  3. Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg. 2002;50:87–91.

    Article  CAS  Google Scholar 

  4. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78:912–7.

    Article  Google Scholar 

  5. Dhadwal K, Al-Ruzzeh S, Athanasiou T, Choudhury M, Tekkis P, Vuddamalay P, et al. Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for sternal wound infection in high-risk patients following coronary artery bypass grafting surgery: a prospective randomised double-blind controlled trial. Heart. 2007;93:1126–33.

    Article  CAS  Google Scholar 

  6. Kouchoukos NT, Wareing TH, Murphy SF, Pelate C, Marshall WG. Risk of bilateral internal mammary artery bypass grafting. Ann Thorac Surg. 1990;49:210–9.

    Article  CAS  Google Scholar 

  7. Grossi EA, Esposito R, Harris LJ, Crooke GA, Galloway AC, Colvin SB, et al. Sternal wound infections and use internal mammary graft. J Thorac Cardiovasc Surg. 1991;102:342–7.

    Article  CAS  Google Scholar 

  8. Vuorisalo S, Haukipuro K, Pokela R, Syrjala H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol. 1998;19:240–7.

    Article  CAS  Google Scholar 

  9. Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM, Fraser VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg. 2002;124:136–45.

    Article  Google Scholar 

  10. Fujii M, Ochi M, Kurita J, Kambe M, Bessho R, Nitta T, Shimizu K. Prevention for surgical site infection after coronary bypass surgery. J Jpn Soc Surg Infect. 2007;4:297–301.

    Google Scholar 

  11. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563–77.

    Article  CAS  Google Scholar 

  12. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38:553–62.

    Article  CAS  Google Scholar 

  13. Glass GE, Murphy GF, Esmaeili A, Lai LM, Nanchahal J. Systematic review of molecular mechanism of action of negative-pressure wound therapy. Br J Surg. 2014;101:1627–36.

    Article  CAS  Google Scholar 

  14. Grauhan O, Navasardyan A, Hofmann M, Müller P, Stein J, Hetzer R. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg. 2013;145:1387–92.

    Article  Google Scholar 

  15. Matatov T, Reddy KN, Doucet LD, Zhao CX, Zhang WW. Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients. J Vasc Surg. 2013;57:791–5.

    Article  Google Scholar 

  16. Ramsey P, White A, Guinn D, Lu GC, Ramin SM, Davies JK, et al. Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery. Obstet Gynecol. 2005;105:967–73.

    Article  Google Scholar 

  17. Cardosi R, Drake J, Holmes S, Tebes SJ, Hoffman MS, Fiorica JV, et al. Subcutaneous management of vertical incisions with three or more centimeters of subcutaneous fat. Am J Obstet Gynecol. 2006;195:607–16.

    Article  Google Scholar 

  18. Inotsume-Kojima Y, Uchida T, Abe M, Doi T, Kanayama N. A combination of subcuticular sutures and a drain for skin closure reduces wound complications in obese women undergoing surgery using vertical incisions. J Hosp Infect. 2011;77:162–5.

    Article  CAS  Google Scholar 

  19. Tsujita E, Yamashita Y, Takeishi K, Matsuyama A, Tsutsui S, Matsuda H, et al. Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg. 2012;36:1651–6.

    Article  Google Scholar 

  20. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8.

    Article  CAS  Google Scholar 

  21. Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser V. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest. 1997;112:666–75.

    Article  CAS  Google Scholar 

  22. Rebollo MH, Bernal JM, Llorca J, Rabasa JM, Revuelta JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg. 1996;112:908–13.

    Article  CAS  Google Scholar 

  23. Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999;117:855–72.

    Article  CAS  Google Scholar 

  24. Puskas JD, Sadiq A, Vassiliades TA, Kilgo PD, Lattouf OM. Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. Ann Thorac Surg. 2012;94:710–6.

    Article  Google Scholar 

  25. Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg. 2000;17:482–4.

    Article  CAS  Google Scholar 

  26. Fleck TM, Fleck M, Moidl R, Czerny M, Koller R, Giovanoli P, et al. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg. 2002;74:1596–600.

    Article  Google Scholar 

  27. Wackenfors A, Sjögren J, Gustafsson R, Algotsson L, Ingemansson R, Malmsjo M. Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood flow. Wound Repair Regen. 2004;12:600–6.

    Article  Google Scholar 

  28. Petzina R, Gustafsson L, Mokhtari A, Ingemansson R, Malmsjo M. Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting. Eur J Cardiothorac Surg. 2006;30:85–9.

    Article  Google Scholar 

  29. Yokoyama T, Hiyama E. Differential diagnosis between superficial incisional surgical site infection and fat necrosis. J Jpn Soc Surg Infect. 2005;2:27–9.

    Google Scholar 

  30. Morykwas MJ, Faler BJ, Pearce DJ, Argenta LC. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg. 2001;47:547–51.

    Article  CAS  Google Scholar 

  31. Gonzalez AC, Costa TF, Andrade ZA, Medrado AR. Wound healing—a literature review. An Bras Dermatol. 2016;91:614–20.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Dr. Kazutora Mizukami (Ph.D. in Statistical Science, President of Medical Data Management in Fukuoka) for the statistical assistance. They would also like to thank Editage (https://www.editage.com) for the English language editing and Ethicon for permission to use the schematic illustration.

Funding

This work was supported by the Nippon Medical School Alumni Association Medical Research Grant.

Author information

Authors and Affiliations

  1. Cardiavascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan

    Masahiro Fujii & Ryuzo Bessho

  2. Cardiavascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-0021, Japan

    Yasuo Miyagi & Takashi Nitta

Authors
  1. Masahiro Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryuzo Bessho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuo Miyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Nitta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masahiro Fujii.

Ethics declarations

Conflict of interest

There are no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujii, M., Bessho, R., Miyagi, Y. et al. Negative-pressure sternal wound closure with interrupted subcuticular suturing and a subcutaneous drain tube reduces the incidence of poststernotomy wound infection after coronary artery bypass grafting surgery. Surg Today 50, 475–483 (2020). https://doi.org/10.1007/s00595-019-01912-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-019-01912-8

Keywords

Search

Navigation