Related Experiment Video
Updated: Aug 23, 2025
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized
Ahmed S Fadaly1, Ghada Mohammed Abdellatif2, Sameh E Saeed1
1Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
Insights
Primary sternal closure is more effective than vacuum-assisted closure for treating pediatric post-cardiac surgery mediastinitis. This technique improves survival, reduces antibiotic use, and shortens hospital stays for better sternal healing.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Infectious Disease Management
Background:
- Mediastinitis is a serious complication following cardiac surgery in children.
- Current treatment options for pediatric post-sternotomy mediastinitis vary.
- Comparing primary sternal closure with vacuum-assisted closure is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the efficacy of primary sternal closure versus vacuum-assisted closure for pediatric post-cardiac surgery mediastinitis.
- To compare outcomes including survival, intravenous drug use, hospital stay, and wound healing.
- To determine if primary sternal closure is a reliable technique for this patient group.
Main Methods:
- A prospective randomized controlled trial involving 217 pediatric patients with post-cardiac surgery mediastinitis.
- Patients were randomized into primary sternal closure (Group A) and vacuum-assisted closure (Group B) groups.
- A 6-month follow-up assessed hospitalization duration, IV drug use, wound complications, sternal stability, and survival.
Main Results:
- Primary sternal closure showed a significantly higher 6-month survival rate (p=0.005).
- The primary closure group required significantly less duration for IV antibiotics (8.55 days vs 32.61 days, p<0.001).
- Patients in the primary closure group experienced shorter hospital stays (15.77 days vs 42.61 days, p<0.001) and better sternal healing.
Conclusions:
- Primary sternal closure is a superior technique for treating pediatric mediastinitis after cardiac surgery compared to vacuum-assisted closure.
- This reinforced sternal closure method offers promising results in reducing IV drug needs, hospitalization duration, and improving survival and wound healing.
Purpose:
To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group.
Materials And Methods:
A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival.
Results:
The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55±3.57 and it was 32.61±8.39 showing high statistically significant difference (p<0.001). Patients in the primary closure group had earlier discharge from hospital 15.77±4.18 than vacuum assisted group 42.61±8.39, with high statistically significant difference (p<0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up.
Conclusion:
Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.
More Related Videos
15:11Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
Published on: January 5, 2015
08:50Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
