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A new clinical classification and reconstructive strategy for post-sternotomy surgical site infection

Kitano, Daiki Takahashi, Hiroaki Nomura, Tadashi Okada, Kenji Terashi, Hiroto Sakakibara, Shunsuke 神戸大学

2022.12

概要

Introduction: Post-sternotomy surgical site infection (SSI) is a serious complication of cardiovascular surgery. Here, we proposed a new clinical classification and reconstructive strategy for this condition.

Methods: A retrospective study based on medical records was performed on 100 consecutive cases requiring wound management by plastic surgeons for post-sternotomy SSI at Kobe University Hospital between January 2009 and December 2021. We classified 100 cases into four categories according to the anatomical invasiveness of the infection (type 1, superficial SSI; type 2, sternal osteomyelitis; type 3, mediastinitis; and type 4, aortic graft infection). The standard treatment plan comprised initial debridement, negative pressure wound therapy with continuous irrigation, and reconstructive surgery. Reconstructive methods and their outcomes (in-hospital mortality rate, follow-up period, and infection recurrence rate) were investigated for each SSI category.

Results: There were nine SSI cases in type 1, 28 in type 2, 25 in type 3, and 38 in type 4. The pectoralis major (PM) muscle advancement flap was mainly selected in types 1 and 2 (100 and 70.4%, respectively), while the omental flap or latissimus dorsi (LD) myocutaneous flaps were mainly selected in types 3 and 4 (77.3 and 81.8%, respectively) for reconstructive surgery. The in-hospital mortality rates for types 1, 2, 3, 4 were 44.4, 3.6, 12.0, and 15.8%, respectively. The mean follow-up periods for types 1, 2, 3, 4 were 542.8, 1514.5, 1154.5, and 831.1 days, respectively. Infection recurrence rates for types 1, 2, 3, 4 were 0, 11.5, 13.3, and 19.2%, respectively. All of these recurrent cases, except for 4 cases of type 4 that required surgical intervention, were treated with conservative wound management.

Conclusion: A volume-rich flap (omental or LD flap) was required to fill the dead space after debridement in mediastinitis (type 3) or aortic graft infection (type 4), whereas superficial SSI (type 1) or sternal osteomyelitis (type 2) received a less-invasive flap (PM muscle advancement flap). Our new classification method was based on the anatomical invasiveness of the infection, providing both a simple and easy diagnosis and definitive treatment strategy.

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参考文献

[1] Berrios-Torress SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection. JAMA Surg 2017;152(8):784e91.

[2] Sainz de la Cuesta R, Mohedano R, Sainz de la Cuesta S, Guzma B, Serrera A, Paulos S, et al. Intraoperative subcutaneous culture as a predictor of surgical site infection in open gynecological surgery. PLoS One 2021;16(1):e0244551.

[3] Kuhme T, Isaksson B, Dahlin LG. Wound contamination in cardiac surgery: a systematic quantitative and qualitative study of the bacterial growth in sternal wounds in cardiac surgery patients. APMIS 2007;115(9):1001e7.

[4] Surgical Site Infection (SSI) Events e January 2022. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/nhsn/pdfs/pscmanual/ 9pscssicurrent.pdf (accessed 2022-3-8).

[5] Bustamante-Munguira J, Herrera-Go´mez F, Ruiz-A´lvarez M, Figuerola- Tejerina A, Herna´ndez-Aceituno A. A new surgical site infection risk score: infection risk index in cardiac surgery. J Clin Med 2019;8(4):480.

[6] Goh SSC. Post-sternotomy mediastinitis in the modern era. J Card Surg 2017;32(9):556e66.

[7] Coselli JS, Ko€ksoy C, LeMaire SA. Management of thoracic aortic graft in- fections. Ann Thorac Surg 1999;67(6):1990e8.

[8] Kitano D, Matsuo J, Sakakibara S, Oomura A, Osaki T, Okada K, et al. Extra- anatomical bypass grafting and latissimus dorsi myocutaneous flap recon- struction for post-sternotomy mediastinitis with prosthetic aortic graft infection. Cureus. 13(9): e18086. doi:10.7759/cureus.18086.

[9] Bianco V, Kilic A, Gleason TG, Arnaoutakis GJ, Sultan I. Management of thoracic aortic graft infections. J Card Surg 2018;33(10):658e65.

[10] Pairolero PC, Arnold PG. Management of infected median sternotomy wounds. Ann Thorac Surg 1986;42(1):1e2.

[11] El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61(3):1030e6.

[12] Jones G, Jurkiewicz MJ, Bostwicket J, Wood R, Bried JT, Culbertson J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 1997;225(6):766e76. ; discussion 776-8.

[13] Mekontso Dessap A, Vivier E, Girou E, Brun-Buisson C, Kirsch M. Effect of time to onset on clinical features and prognosis of post-sternotomy mediastinitis. Clin Microbiol Infect 2011;17(2):292e9.

[14] van Wingerden JJ, Ubbink DT, van der Horst CM, de Mol BA. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive man- agement based on evidence from a structured review. J Cardiothorac Surg 2014;19:179.

[15] Anger J, Dantas DC, Arnoni RT, Farsky PS. A new classification of post- sternotomy dehiscence. Rev Bras Cir Cardiovasc 2015;30(1):114e8.

[16] CDC/NHSN Surveillance Definition of Specific Types of Infections e January 2022. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/ nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf (accessed 2022-3-8).

[17] Ikeno Y, Sakakibara S, Yokawa K, Kitani K, Nakai H, Yamanaka K, et al. Post- sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement. Eur J Cardiothorac Surg 2019;55(5):975e83.

[18] Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013;48:452e8.

[19] Kitano D, Sakakibara S, Yamanaka K, Osaki T, Nomura T, Okada K, et al. Versatility of anterolateral partial sternotomy for mediastinal reconstruction with trans-thoracic latissimus dorsi muscle flap in aortic graft infection. Int J Surg Wound Care 2022;3(3):81e7.

[20] Kitano D, Sakakibara S, Osaki T, Maruguchi H, Nomura T, Terashi H. Late-onset post-sternotomy mediastinitis with hematogenous metastasis of infection in hemodialysis patient. Int J Surg Wound Care 2021;4(2):107e10.

[21] Kitano D, Kitamura Y, Yonezawa K, Nishio W, Iwae S, Nakahara M, et al. Combined type mediastinitis after thyroidectomy managed by negative pressure wound therapy with instillation; a case report. Eplasty 2019;19:ic10. eCollection 2019.

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