Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal
Aathira Pradeep1, Jayakumar Rangasamy1, Praveen Kerala Varma2
1Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India.
Abstract:
One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram-negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.
Insights
Preventing sternal wound infections after cardiac surgery is crucial. This review examines current practices and biomaterial research for controlling bleeding, infection, and enhancing sternal healing.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Sternal wound infections, including superficial and deep sternal wound infection (mediastinitis), are significant risks following cardiac surgery.
- These infections are often caused by Staphylococcus organisms and can be exacerbated by materials like bone wax, which may harbor bacteria.
- Current methods for hemostasis and sternal closure include electrocautery, bone wax, and wire cerclage.
Purpose of the Study:
- To review current clinical strategies for preventing post-sternotomy infections and bleeding.
- To highlight research advancements in biomaterials aimed at improving sternal healing and infection control.
- To evaluate the outcomes of novel approaches in managing bleeding, infection, and sternal wound healing.
Main Methods:
- Literature review of clinical practices in cardiac surgery for sternal wound management.
- Analysis of research on biomaterials developed for infection prevention and sternal healing.
- Evaluation of reported outcomes regarding bleeding control, infection rates, and sternal healing enhancement.
Main Results:
- Bone wax, commonly used for hemostasis, may contribute to sternal wound infections.
- Various biomaterials have been developed with reported positive and negative impacts on infection and healing.
- Current research focuses on innovative materials to mitigate infection and promote sternal repair.
Conclusions:
- Effective prevention of sternal wound infection and bleeding is critical in cardiac surgery.
- Biomaterial research offers promising avenues for improving sternal healing and reducing infection risks.
- Further investigation into the efficacy and safety of novel biomaterials is warranted.
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