[Clinical efficacy of multidisciplinary team collaboration in the treatment of deep sternal wound infection]

Objective: To evaluate the clinical efficacy of multidisciplinary team (MDT) collaboration in the treatment of deep sternal wound infection (DSWI). Methods: This study was a historical controlled trial. According to the diagnosis and treatment model adopted by the patients, 23 DSWI patients who met the selection criteria and were treated in the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University from June 2022 to March 2023 using the traditional single discipline led diagnosis and treatment model were included in non-MDT group, including 13 males and 10 females, aged (56±11) years; 25 DSWI patients who met the inclusion criteria and were treated using MDT diagnosis and treatment model in the unit from April 2023 to May 2024 were included in MDT group, including 12 males and 13 females, aged (54±10) years. For patients in MDT group, after admission, the MDT, composed of chief physicians from 13 departments including burns and cutaneous surgery, cardiothoracic surgery, intensive care medicine, anesthesiology, pharmacy, nutrition, endocrinology, vascular surgery, laboratory medicine, radiology, ultrasound, transfusion, and rehabilitation, jointly evaluated the condition and developed personalized plans for systematic diagnosis and treatment. For patients in non-MDT group, the diagnosis and treatment were led by surgeons from department of burns and cutaneous surgery after admission. When specialist care was limited, consultation with physicians from relevant departments were requested as needed, and a comprehensive plan for diagnosis and treatment was formulated after summarizing the consultation opinions. Once the conditions of patients in both groups stabilized, a thorough debridement of the chest wound was performed, followed by repair surgery with unilateral or bilateral pectoralis major muscle flap or combined rectus abdominis muscle flap. The time from the first surgery for the infected wound to healing, the number of surgeries performed from admission to wound healing, intraoperative blood loss, and operation duration, perioperative complications, wound infection recurrence within 15 d after muscle flap repair surgery, and corresponding incidences of complications and recurrence of wound infection were recorded, and the patient's satisfaction score evaluated using the Patient Satisfaction Scale at discharge. Results: The time from the first surgery for the infected wound to healing of patients in MDT group was (12.5±2.8) d, which was significantly shorter than (16.3±2.7) d in non-MDT group (with mean difference of -3.8 d, 95% confidence interval of -5.4 to -2.2 d, t=-4.78, P<0.05). Compared with those in non-MDT group, the number of surgeries performed from admission to wound healing and intraoperative blood loss of patients in MDT group were significantly reduced (Z=-2.54, t=-2.20, P<0.05), and the operation duration was significantly shortened (t=-3.41, P<0.05). During the perioperative period, in MDT group, one patient experienced delayed wound healing, and one patient developed a pulmonary infection; in non-MDT group, two patients experienced delayed wound healing, one patient developed pulmonary infection, and two patients developed deep vein thrombosis in the lower limbs. Wound infection recurrence within 15 d after muscle flap repair surgery occurred in one patient in MDT group and 4 patients in non-MDT group, all of whom healed after dressing change. There were no statistically significant differences in the incidence of perioperative complication or wound infection recurrence within 15 d after muscle flap repair surgery between the two groups of patients (P>0.05). The patient's satisfaction score at discharge in MDT group was 97.7±2.4, which was significantly higher than 95.1±3.5 in non-MDT group (t=3.04, P<0.05). Conclusions: For DSWI patients, the MDT diagnosis and treatment model can optimize the treatment plan through joint assessment by physicians from multiple disciplines. It significantly shortens the wound healing time, reduces the number of surgeries and intraoperative blood loss, and improves patient satisfaction without increasing the risk of complications or wound infection recurrence, which is worthy of clinical promotion and application.