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Review
. 2014 Sep 30;9(3):Doc19.
doi: 10.3205/dgkh000239. eCollection 2014.

Can post-sternotomy mediastinitis be prevented by a closed incision management system?

Pascal M Dohmen  1 , Thanasie Markou  2 , Richard Ingemansson  3 , Heinrich Rotering  4 , Jean M Hartman  5 , René van Valen  6 , Maaike Brunott  6 , Axel Kramer  7 , Patrique Segers  8
Affiliations
Review

Can post-sternotomy mediastinitis be prevented by a closed incision management system?

Pascal M Dohmen et al. GMS Hyg Infect Control. .

Abstract
in English, German

Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today's golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today's studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction.

Mediastinitis bei Zustand nach Sternotomie ist eine ernste Komplikation nach herz- und thoraxchirurgischen Eingriffen, die durch eine Vielzahl von Faktoren beeinflusst wird. Sie ist mit erhöhter Morbidität, Mortalität und behandlungsassoziierten Kosten verbunden. Die Vakuumtherapie ist der heutige Standard zur Mediastinitisbehandlung bei Zustand nach Sternotomie. Im vorliegenden Minireview wird analysiert, ob der Vakuumverband auch in die Lage ist, einer Mediastinitis vorzubeugen. Im Ergebnis einer systematischen Literaturrecherche in PubMed wurde festgestellt, dass die Anwendung des Vakuum-assoziierten Verschlusses eine Reduktion der Mediastinitis zur Folge hatte. Ebenso konnten die behandlungsassoziierten Kosten gesenkt werden. Allerdings waren in allen Studien nur Hoch-Risiko-Patienten eingeschlossen, sodass dringend weiterte Studien zur Absicherung der Ergebnisse einschließlich der Abklärung von Risikofaktoren benötigt werden.

Keywords: cardiothoracic surgery; closed incision management; incisional negative pressure therapy; negative pressure wound therapy (NPWT); surgical site infection; surgical wounds.

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References

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