FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2063447495> ?p ?o ?g. }

• W2063447495 endingPage "1096" @default.
• W2063447495 startingPage "1094" @default.
• W2063447495 abstract "We present 3 cases of pediatric post-sternotomy mediastinitis treated by a vacuum-assisted closure (VAC). The patients 2 girls, aged 6 months and 10 months, and a 2-year-old boy. The onset of infection was at 9, 14, and 32 postoperative days. The culture examination detected coagulase-negative Staphylococci strains in 2 cases, and Staphylococcus aureus in 1 case. A VAC was performed at −50 mm Hg for 10, 12, and 7 days. The wounds were closed without vascularized soft tissue. A VAC under a low negative pressure is a useful and safe procedure for the management of pediatric post-sternotomy mediastinitis. We present 3 cases of pediatric post-sternotomy mediastinitis treated by a vacuum-assisted closure (VAC). The patients 2 girls, aged 6 months and 10 months, and a 2-year-old boy. The onset of infection was at 9, 14, and 32 postoperative days. The culture examination detected coagulase-negative Staphylococci strains in 2 cases, and Staphylococcus aureus in 1 case. A VAC was performed at −50 mm Hg for 10, 12, and 7 days. The wounds were closed without vascularized soft tissue. A VAC under a low negative pressure is a useful and safe procedure for the management of pediatric post-sternotomy mediastinitis. Post-sternotomy mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery [1Al-Sehly A.A. Robinson J.L. Lee B.E. et al.Pediatric poststernotomy mediastinitis.Ann Thorac Surg. 2005; 80: 2314-2320Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar]. At the present time, there is no general consensus regarding the appropriate surgical approach to mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a novel treatment with an ingenious mechanism, and recent publications have demonstrated encouraging clinical results [2Fuchs 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; 79: 526-531Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar]. However, the validity of VAC therapy for managing pediatric post-sternotomy mediastinitis remains to be confirmed because there have been very few reports published on this topic [3Salazard B. Niddam J. Ghez O. Metras D. Magalon G. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis in the paediatric patient.J Plast Reconstr Aesthet Surg. 2007; (June 21, 2007 [Epub ahead of print])Google Scholar, 4Fleck T. Simon P. Burda G. Wolner E. Wollenek G. Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants.Interact Cardiovasc Thorac Surg. 2006; 5: 285-288Crossref PubMed Scopus (33) Google Scholar]. We herein describe 3 cases of pediatric post-sternotomy mediastinitis treated by VAC therapy. Patient 1 was a 6-month-old girl who underwent a bilateral bidirectional Glenn shunt procedure for a tricuspid atresia with a concomitant pulmonary atresia. The surgery was performed urgently owing to clinical deterioration, as evidenced by the progression of cyanosis, which required intubation and mechanical control of ventilation. Nine days after surgery, she was noted to have a purulent discharge from the median sternal wound and a high-grade fever. Removal of the sternal wires and surgical debridement were performed. Thereafter, polyurethane foam, which was shaped to fit the defect, was placed within the cavity. The area was covered with an adhesive drape, and suction drainage was carried out at −50 mm Hg for 10 days in addition to the administration of appropriate antibiotics. Coagulase-negative Staphylococci strains were detected by the culture examination. The polyurethane foam was replaced every few days. The VAC therapy lasted for 10 days. The wound was closed without any surgical revisions at 3 days after the discontinuation of VAC (Fig 1). Patient 2 was a 2-year old boy who underwent a pacemaker implantation using myocardial leads for a sick sinus syndrome. A total anomalous pulmonary venous connection repair and a release of a pulmonary venous obstruction were performed twice before this operation. The patient was noted to have a high-grade fever and a purulent discharge from the median sternal wound 14 days after surgery. Coagulase-negative Staphylococci strains were detected by the culture examination. Debridement of infected tissue was performed at the time of VAC application. We employed VAC therapy for 12 days until the wound became smaller and granulation tissue proliferated, in addition to the administration of appropriate antibiotics. However, there was still a small defect in the epithelialization. Finally, a second primary closure was performed at 4 weeks after VAC application. Patient 3 was a 10-month old girl who underwent a ventricular septal defect (VSD) repair. After she was discharged from the hospital (postoperative day 32), she was noted to have a high-grade fever and a purulent discharge from the median sternal wound. Staphylococcus aureus was detected by the culture examination. Debridement of the infected tissue was performed at the time of VAC application. The VAC therapy was applied for a week with the administration of appropriate antibiotics. Subsequently, a second primary closure was carried out. Mediastinitis is a significant postoperative complication that affects 0.4% to 5.0% of all pediatric patients undergoing median sternotomy [4Fleck T. Simon P. Burda G. Wolner E. Wollenek G. Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants.Interact Cardiovasc Thorac Surg. 2006; 5: 285-288Crossref PubMed Scopus (33) Google Scholar]. The conventional techniques for the treatment of mediastinitis currently include a debridement followed by a closure with vascularized soft tissue, such as omentum and muscle flaps, and a primary closure with several days to a week of closed suction drainage, with or without antimicrobial irrigation, but the details of the surgical treatment remain controversial [1Al-Sehly A.A. Robinson J.L. Lee B.E. et al.Pediatric poststernotomy mediastinitis.Ann Thorac Surg. 2005; 80: 2314-2320Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar]. Vacuum-assisted closure is a technical innovation in wound care. However, the validity of using the VAC therapy to manage pediatric post-sternotomy mediastinitis is not clear. We therefore describe 3 cases of pediatric post-sternotomy mediastinitis treated by the VAC therapy. For all 3 cases in our series, surgical debridement was performed at the same time as the VAC therapy. We therefore believe that it is very important to remove necrotic and infected tissue before VAC implantation to obtain successful results. There are several advantageous features derived from the application of negative pressure to a sternal wound. Vacuum-assisted closure allows for an open drainage, which continuously removes the exudate with a simultaneous stabilization of the chest and the isolation of the wound, and which stimulates the formation of granulation tissue by maintaining a moist environment. Furthermore, patients can be mobilized early and can receive physiotherapy to minimize further complications. The most commonly used pressure in the clinical situation is −125 mm Hg in adults [5Mokhtari A. Petzina R. Gustafsson L. et al.Sternal stability at different negative pressures during vacuum-assisted closure therapy.Ann Thorac Surg. 2006; 82: 1063-1067Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar]. This pressure is based on the previous basic research [6Morykwas M.J. Faler B.J. Pearce D.J. Argenta L.C. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine.Ann Plast Surg. 2001; 47: 547-551Crossref PubMed Scopus (289) Google Scholar]. However, there are important aspects that require consideration when VAC is applied to a sternotomy wound. Because of the vital structures in the thoracic cavity, the interaction between the polyurethane foam and the surrounding tissue is of importance. It has been proposed that a less negative pressure might lead to insufficient sternal stability. On the other hand, too high of a negative pressure applied to the mediastinum has been suggested to be a risk for damage of the heart. Furthermore, it seems that the tissue of pediatric organs is more fragile than that of adults. Mokhtari and colleagues [5Mokhtari A. Petzina R. Gustafsson L. et al.Sternal stability at different negative pressures during vacuum-assisted closure therapy.Ann Thorac Surg. 2006; 82: 1063-1067Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar] reported that low negative pressures (-50 to −100 mm Hg) stabilize the sternum just as efficiently as do high negative pressures (-150 to −200 mm Hg), and the foam at a low negative pressure adapts better to the shape of the wound than at a high negative pressure in a porcine model [7Sjogren J. Gustafsson R. Wackenfors A. Malmsjo M. Algotsson L. Ingemansson R. Effects of vacuum-assisted closure on central hemodynamics in sternotomy wound model.Interact Cardiovasc Thorac Surg. 2004; 3: 666-671Crossref PubMed Scopus (22) Google Scholar]. In fact, VAC therapy at a low negative pressure (-50 or −75 mm Hg) for pediatric post-sternotomy mediastinitis has been recently reported [3Salazard B. Niddam J. Ghez O. Metras D. Magalon G. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis in the paediatric patient.J Plast Reconstr Aesthet Surg. 2007; (June 21, 2007 [Epub ahead of print])Google Scholar, 4Fleck T. Simon P. Burda G. Wolner E. Wollenek G. Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants.Interact Cardiovasc Thorac Surg. 2006; 5: 285-288Crossref PubMed Scopus (33) Google Scholar]. No troublesome complications such as massive air leakage, insufficient drainage, or tissue damage were encountered during VAC therapy under a pressure of −50 mm Hg in our series. In conclusion, VAC therapy can be successfully performed for the treatment of pediatric post-sternotomy mediastinitis, and it is thought to be a useful alternative option for the treatment of pediatric deep sternal infection." @default.
• W2063447495 created "2016-06-24" @default.
• W2063447495 creator A5011295683 @default.
• W2063447495 creator A5036027163 @default.
• W2063447495 creator A5055475163 @default.
• W2063447495 creator A5064910645 @default.
• W2063447495 creator A5072721261 @default.
• W2063447495 creator A5075739341 @default.
• W2063447495 creator A5081546269 @default.
• W2063447495 date "2008-03-01" @default.
• W2063447495 modified "2023-10-12" @default.
• W2063447495 title "Vacuum-Assisted Closure for Pediatric Post-Sternotomy Mediastinitis: Are Low Negative Pressures Sufficient?" @default.
• W2063447495 cites W1972838991 @default.
• W2063447495 cites W1974593633 @default.
• W2063447495 cites W1983585710 @default.
• W2063447495 cites W2004698582 @default.
• W2063447495 cites W2081333189 @default.
• W2063447495 cites W2082925748 @default.
• W2063447495 doi "https://doi.org/10.1016/j.athoracsur.2007.09.004" @default.
• W2063447495 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/18291211" @default.
• W2063447495 hasPublicationYear "2008" @default.
• W2063447495 type Work @default.
• W2063447495 sameAs 2063447495 @default.
• W2063447495 citedByCount "37" @default.
• W2063447495 countsByYear W20634474952012 @default.
• W2063447495 countsByYear W20634474952013 @default.
• W2063447495 countsByYear W20634474952014 @default.
• W2063447495 countsByYear W20634474952015 @default.
• W2063447495 countsByYear W20634474952017 @default.
• W2063447495 countsByYear W20634474952018 @default.
• W2063447495 countsByYear W20634474952019 @default.
• W2063447495 countsByYear W20634474952020 @default.
• W2063447495 countsByYear W20634474952021 @default.
• W2063447495 countsByYear W20634474952022 @default.
• W2063447495 crossrefType "journal-article" @default.
• W2063447495 hasAuthorship W2063447495A5011295683 @default.
• W2063447495 hasAuthorship W2063447495A5036027163 @default.
• W2063447495 hasAuthorship W2063447495A5055475163 @default.
• W2063447495 hasAuthorship W2063447495A5064910645 @default.
• W2063447495 hasAuthorship W2063447495A5072721261 @default.
• W2063447495 hasAuthorship W2063447495A5075739341 @default.
• W2063447495 hasAuthorship W2063447495A5081546269 @default.
• W2063447495 hasBestOaLocation W20634474951 @default.
• W2063447495 hasConcept C141071460 @default.
• W2063447495 hasConcept C146834321 @default.
• W2063447495 hasConcept C162324750 @default.
• W2063447495 hasConcept C2781101105 @default.
• W2063447495 hasConcept C34447519 @default.
• W2063447495 hasConcept C42219234 @default.
• W2063447495 hasConcept C71924100 @default.
• W2063447495 hasConceptScore W2063447495C141071460 @default.
• W2063447495 hasConceptScore W2063447495C146834321 @default.
• W2063447495 hasConceptScore W2063447495C162324750 @default.
• W2063447495 hasConceptScore W2063447495C2781101105 @default.
• W2063447495 hasConceptScore W2063447495C34447519 @default.
• W2063447495 hasConceptScore W2063447495C42219234 @default.
• W2063447495 hasConceptScore W2063447495C71924100 @default.
• W2063447495 hasIssue "3" @default.
• W2063447495 hasLocation W20634474951 @default.
• W2063447495 hasLocation W20634474952 @default.
• W2063447495 hasOpenAccess W2063447495 @default.
• W2063447495 hasPrimaryLocation W20634474951 @default.
• W2063447495 hasRelatedWork W2003938723 @default.
• W2063447495 hasRelatedWork W2047967234 @default.
• W2063447495 hasRelatedWork W2118496982 @default.
• W2063447495 hasRelatedWork W2369148130 @default.
• W2063447495 hasRelatedWork W2406304750 @default.
• W2063447495 hasRelatedWork W2413990458 @default.
• W2063447495 hasRelatedWork W2439875401 @default.
• W2063447495 hasRelatedWork W4252318510 @default.
• W2063447495 hasRelatedWork W4298382360 @default.
• W2063447495 hasRelatedWork W2525756941 @default.
• W2063447495 hasVolume "85" @default.
• W2063447495 isParatext "false" @default.
• W2063447495 isRetracted "false" @default.
• W2063447495 magId "2063447495" @default.
• W2063447495 workType "article" @default.