Novosti
Khirurgii

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Year 2016 Vol. 24 No 3

REVIEWS

A.I. PROTASEVICH, A.A. TATUR

EFFICIENCY OF VACUUM THERAPY IN TREATMENT OF POSTOPERATIVE STERNOMEDIASTINITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

EE "Belarusian State Medical University"
The Republic of Belarus

Objectives. Efficacy estimation of vacuum-assisted closure therapy (VAC) in comparison with conventional methods in the treatment of deep sternal infection following cardiothoracic surgery by carrying out systematic review and meta-analysis of study publications devoted to the given problem.
Methods. A systematic search was conducted (PubMed, elibrary.ru, hand search) for studies dedicated to the comparative analysis of vacuum-assisted closure therapy efficacy and a conventional treatment of deep sternal infection (1997-2015 yrs). The Newcastle-Ottawa Scale (NOS) for assessing the quality of methodology of the study was used. Mortality was considered the primary outcome, secondary outcome – duration of therapy and disease recurrences. The results were presented as odds ratios (ORs) 95% of confidence interval (CI). Statistical heterogeneity was assessed using Q-test and I2-test.
Results. For the analysis 26 non-randomized, retrospective, cohort studies published from 1997 to September 2015, including the results of treatment of postoperative sternal infections in 2616 patients were selected. It was found in the case of using the VAC-therapy the lethality was significantly lower than in conventional treatment (2233 patients; OR=0,40; 95% CI 0,28-0,57; ð<0,0001; I2=0%). VAC-therapy use was associated with fewer recurrences (1322 patients; OR=0,27; 95% CI 0,16-0,45; ð<0,0001; I2 =23%). A significant reduction of the therapy duration had been revealed (1577 patients; mean difference -5,86 days; 95% CI -9,40: -1,08; ð=0,02) with high heterogeneity between studies (I2 =87%).
Conclusion. The systematic review and meta-analysis suggest that VAC- therapy might be more effective than a conventional one in treatment of deep sternal infections. However, randomized studies are required to confirm the potential value of this type of treatment.

Keywords: sternomediastinitis, deep sternal infection, vacuum assisted closure, meta-analysis, local negative pressure, lethality
p. 275-284 of the original issue
References
  1. Mauermann WJ, Sampathkumar P, Thompson RL. Sternal wound infections. Best Pract Res Clin Anaesthesiol. 2008 Sep;22(3):423-36.
  2. Ennker IC, Pietrowski D, Vöhringer L, Kojcici B, Albert A, Vogt PM, et al. Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis. J Plast Reconstr Aesthet Surg. 2009 Nov;62(11):1479-83. doi: 10.1016/j.bjps.2008.05.017.
  3. van Wingerden JJ, Ubbink DT, van der Horst CM, de Mol BA. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review. J Cardiothorac Surg. 2014 Nov 23;9:179. doi: 10.1186/s13019-014-0179-4.
  4. Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010 Apr;37(4):893-6. doi: 10.1016/j.ejcts.2009.10.005.
  5. Robicsek F. Postoperative sterno-mediastinitis. Am Surg. 2000 Feb;66(2):184-92.
  6. 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 Jun;38(6):553-62.
  7. Obdeijn MC, de Lange MY, Lichtendahl DH, de Boer WJ. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. Ann Thorac Surg. 1999 Dec;68(6):2358-60.
  8. Eyileten Z, Akar AR, Eryilmaz S, Sirlak M, Yazicioglu L, Durdu S, et al. Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery. Surg Today. 2009;39(11):947-54. doi: 10.1007/s00595-008-3982-5.
  9. Frerichs O, Brüner S, Fansa H. Der Stellenwert der V.A.C.®-Therapie bei Sternumosteomyelitis. Zentralbl Chir. 2006;131:120-23. doi: 10.1055/s-2006-921459.
  10. Fuchs U, Zittermann A, Stuettgen B, Groening A, Minami K, Koerfer R. Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. Ann Thorac Surg. 2005 Feb;79(2):526-31.
  11. Immer FF, Durrer M, Mühlemann KS, Erni D, Gahl B, Carrel TP. Deep sternal wound infection after cardiac surgery: modality of treatment and outcome. Ann Thorac Surg. 2005 Sep;80(3):957-61.
  12. Segers P, de Jong AP, Kloek JJ, de Mol BAJ. M Poststernotomy mediastinitis: comparison of two treatment modalities. Interact CardioVasc Thorac Surg. 2005;4(6):555-60. doi: 10.1510/icvts.2005.112714.
  13. Sjögren J, Gustafsson R, Nilsson J, Malmsjö M, Ingemansson R. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg. 2005 Jun;79(6):2049-55.
  14. Simek M, Nemec P, Zalesak B, Kalab M, Hajek R, Jecminkova L, et al. Vacuum-assisted closure in the treatment of sternal wound infection after cardiac surgery. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007 Dec;151(2):295-99.
  15. Doss M, Martens S, Wood JP, Wolff JD, Baier C, Moritz A. Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiothorac Surg. 2002 Dec;22(6):934-38.
  16. Catarino PA, Chamberlain MH, Wright NC, Black E, Campbell K, Robson D, et al. High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis. Ann Thorac Surg. 2000 Dec;70(6):1891-95.
  17. Damiani G, Pinnarelli L, Sommella L, Tocco MP, Marvulli M, Magrini P, et al. Vacuum-assisted closure therapy for patients with infected sternal wounds: a meta-analysis of current evidence. J Plast Reconstr Aesthet Surg. 2011 Sep;64(9):1119-23. doi: 10.1016/j.bjps.2010.11.022.
  18. Falagas ME, Tansarli GS, Kapaskelis A, Vardakas KZ. Impact of vacuum-assisted closure (VAC) therapy on clinical outcomes of patients with sternal wound infections: a meta-analysis of non-randomized studies. PLoS One. 2013 May 31;8(5):e64741. doi: 10.1371/journal.pone.0064741.
  19. Pan A, De Angelis G, Nicastri E, Sganga G, Tacconelli E. Topical negative pressure to treat surgical site infections, with a focus on post-sternotomy infections: a systematic review and meta-analysis. Infection. 2013 Dec;41(6):1129-35. doi: 10.1007/s15010-013-0536-6.
  20. Ruzmatov TM, Efendiev VU, Boboshko AV, Malakhov ES, Nesmachnyi AS, Razumakhin RA, i dr. Vakuumnaia terapiia posleoperatsionnogo sternomediastinita [Vacuum therapy postoperative sternomediastinit]. Khirurgiia Zhurn im NI Pirogova. 2015;(8):14-17.
  21. Yumun G, Erdolu B, Toktas F, Eris C, Ay D, Turk T, et al. Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality. Heart Surg Forum. 2014 Aug;17(4):E212-6. doi: 10.1532/HSF98.2014346.
  22. Gorbunov VA, Dzhordzhikiia RK, Vagizov II, Abdul'ianov VA, Abdul'ianov IV, Mukhariamov MN, i dr. Sravnitel'nyi analiz rezul'tatov khirurgicheskogo lecheniia poststernotomnogo mediastinita u kardiokhirurgicheskikh patsientov [The comparative analysis of results of surgical treatment poststernotomic mediastinitis in cardiac surgical patients]. Kazan Med Zhurn. 2013;(6):826-31.
  23. Rodriguez Cetina Biefer H, Sündermann SH, Emmert MY, Rancic Z, Salzberg SP, Grünenfelder J, et al. Negative microbiological results are not mandatory in deep sternal wound infections before wound closure. Eur J Cardiothorac. Surg. 2012;42(2):306-10. doi: 10.1093/ejcts/ezr326.
  24. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010. Available from: http://www.ohri.ca/programs/ clinical epidemiology/oxford.asp.
  25. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Available from: http://handbook.cochrane.org.
  26. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719-48. doi: 10.1093/jnci/22.4.719.
  27. Deniz H, Gokaslan G, Arslanoglu Y, Ozcaliskan O, Guzel G, Yasim A, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg. 2012 Jul 11;7:67. doi: 10.1186/1749-8090-7-67.
  28. Fleck T, Fleck M. Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery. Int Wound J. 2014 Jun;11(3):240-45. doi: 10.1111/j.1742-481X.2012.01079.x.
  29. Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg. 2010 May;89(5):1502-9. doi: 10.1016/j.athoracsur.2010.02.038.
  30. Simek M, Hajek R, Fluger I, Molitor M, Grulichova J, Langova K, et al. Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery. J Cardiovasc Surg (Torino). 2012 Feb;53(1):113-20.
  31. Steingrimsson S, Gottfredsson M, Gudmundsdottir I, Sjögren J, Gudbjartsson T. Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections. Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):406-10. doi: 10.1093/icvts/ivs254.
  32. Vos RJ, Yilmaz A, Sonker U, Kelder JC, Kloppenburg GT. Primary closure using Redon drains vs vacuum-assisted closure in post-sternotomy mediastinitis. Eur J Cardiothorac Surg. 2012 Oct;42(4):e53-7. doi: 10.1093/ejcts/ezs404.
  33. Porkhanov VA, Poliakov IS, Kovalenko AL, Sirota AA. Sovremennaia taktika lecheniia posleoperatsionnykh sternomediastinitov s ispol'zovaniem vakuumnykh poviazok [Modern tactics of treatment of postoperative sternomediastinits using a vacuum bandage. Wounds and wound infections: I Intern Congress materials;]. Rany i ranevye infektsii: materialy I Mezhdunar kongr; 2012 Okt 11-13; Moscow, Ros Federatsiia. p.
  34. Assmann A, Boeken U, Feindt P, Schurr P, Akhyari P, Lichtenberg A. Vacuum-assisted wound closure is superior to primary rewiring in patients with deep sternal wound infection. Thorac Cardiovasc Surg. 2011 Feb;59(1):25-9. doi: 10.1055/s-0030-1250598.
  35. De Feo M, Vicchio M, Santè P, Cerasuolo F, Nappi G. Evolution in the treatment of mediastinitis: single-center experience. Asian Cardiovasc Thorac Ann. 2011 Feb;19(1):39-43. doi: 10.1177/0218492310395789.
  36. Kobayashi T, Mikamo A, Kurazumi H, Suzuki R, Shirasawa B, Hamano K. Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery. J. Cardiothorac. Surg. 2011;56. doi: 10.1186/1749-8090-6-56.
  37. Morisaki A, Hosono M, Sasaki Y, Hirai H, Sakaguchi M, Nakahira A. et al. Evaluation of risk factors for hospital mortality and current treatment for poststernotomy mediastinitis. Gen Thorac Cardiovasc Surg. 2011 Apr;59(4):261-67. doi: 10.1007/s11748-010-0727-3.
  38. Baillot R, Cloutier D, Montalin L, Coté L, Lellouche F, Houde C, et al. Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies. Eur J Cardiothorac Surg. 2010 Apr;37(4):880-7. doi: 10.1016/j.ejcts.2009.09.023.
  39. Petzina R, Hoffmann J, Navasardyan A, Malmsjö M, Stamm C, Unbehaun A, et al. Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment. Eur J Cardiothorac Surg. 2010 Jul;38(1):110-3. doi: 10.1016/j.ejcts.2010.01.028.
Address for correspondence:
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
1-ya kafedra khirurgicheskih bolezney,
tel. office: 375 29 771-43-01,
e-mail: aprot@yandex.ru,
Protasevich Aleksey Ivanovich
Information about the authors:
Protasevich A.I. PhD, an associate professor of the 1st chair of surgical diseases of EE "Belarusian State Medical University".
Tatur A.A. MD, professor of the 1st chair of surgical diseases of EE "Belarusian State Medical University".
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