Subscribe to RSS
DOI: 10.1055/s-0032-1304537
Incidence of Deep Sternal Wound Infection Is Not Reduced with Autologous Platelet Rich Plasma in High-Risk Cardiac Surgery Patients[*]
Publication History
27 July 2011
11 November 2011
Publication Date:
30 April 2012 (online)
Abstract
Background Deep sternal wound infections (DSWI) remain a devastating complication in cardiac surgery applying full sternotomy. As the risk profile in cardiac surgery changed toward an older and sicker population, the incidence of DSWI increases. Platelet rich plasma (PRP) holds promise in tissue regeneration with respect to bone regeneration, reduction of bleeding, and accelerated wound healing. The effect of PRP on DSWI was investigated in high-risk patients undergoing cardiac surgery with full sternotomy.
Methods 196 consecutive patients at risk of DSWI were randomized to application of autologous PRP before sternal wiring (n = 97) or control (n = 99). All patients underwent cardiac surgery on cardiopulmonary bypass with cardioplegic cardiac arrest. Endpoint was occurrence of DSWI requiring revision surgery.
Results Demographic, intraoperative, and perioperative variables as well as risk factors were comparable between groups. Incidence of DSWI was not different between the PRP-group and the control-group (6/97 (6.2%) vs. 3/99 (3.0%); n.s.).
Conclusions Local application of autologous PRP in cardiac surgery patients with full sternotomy at high risk for sternal complications did not reduce the incidence of DSWI.
* This study was supported by Biomet Deutschland GmbH, Berlin, Germany.
-
References
- 1 Sachithanandan A, Nanjaiah P, Nightingale P , et al. Deep sternal wound infection requiring revision surgery: impact on mid-term survival following cardiac surgery. Eur J Cardiothorac Surg 2008; 33 (4) 673-678
- 2 Toumpoulis IK, Anagnostopoulos CE, Derose Jr JJ, Swistel DG. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest 2005; 127 (2) 464-471
- 3 Hollenbeak CS, Murphy DM, Koenig S, Woodward RS, Dunagan WC, Fraser VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000; 118 (2) 397-402
- 4 Danner BC, Zenker D, Didilis VN , et al. Transposition of greater omentum in deep sternal wound infection caused by methicillin-resistant Staphylococci, with differing clinical course for MRSA and MRSE. Thorac Cardiovasc Surg 2011; 59 (1) 21-24
- 5 Diez C, Koch D, Kuss O, Silber RE, Friedrich I, Boergermann J. Risk factors for mediastinitis after cardiac surgery—a retrospective analysis of 1700 patients. J Cardiothorac Surg 2007; 2: 23
- 6 Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg 2010; 89 (5) 1502-1509
- 7 Gummert JF, Barten MJ, Hans C , et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002; 50 (2) 87-91
- 8 Gummert JF, Funkat A, Beckmann A , et al. Cardiac surgery in Germany during 2009. A report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2010; 58 (7) 379-386
- 9 Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg 2006; 118 (6) 147e-159e
- 10 Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br 2009; 91 (8) 987-996
- 11 El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996; 61 (3) 1030-1036
- 12 Schimmer C, Sommer SP, Bensch M, Leyh R. Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers. Interact Cardiovasc Thorac Surg 2007; 6 (6) 708-711
- 13 Buchwald D, Kaltschmidt C, Haardt H, Laczkovics A, Reber D. Autologous platelet gel fails to show beneficial effects on wound healing after saphenectomy in CABG patients. J Extra Corpor Technol 2008; 40 (3) 196-202
- 14 Almdahl SM, Veel T, Halvorsen P, Vold MB, Mølstad P. Randomized prospective trial of saphenous vein harvest site infection after wound closure with and without topical application of autologous platelet-rich plasma. Eur J Cardiothorac Surg 2011; 39 (1) 44-48
- 15 Englert SJ, Estep TH, Ellis-Stoll CC. Autologous platelet gel applications during cardiovascular surgery: effect on wound healing. J Extra Corpor Technol 2005; 37 (2) 148-152
- 16 Vang SN, Brady CP, Christensen KA , et al. Autologous platelet gel in coronary artery bypass grafting: effects on surgical wound healing. J Extra Corpor Technol 2007; 39 (1) 31-38
- 17 Trowbridge CC, Stammers AH, Woods E, Yen BR, Klayman M, Gilbert C. Use of platelet gel and its effects on infection in cardiac surgery. J Extra Corpor Technol 2005; 37 (4) 381-386
- 18 Khalafi RS, Bradford DW, Wilson MG. Topical application of autologous blood products during surgical closure following a coronary artery bypass graft. Eur J Cardiothorac Surg 2008; 34 (2) 360-364
- 19 Litmathe J, Philipp C, Kurt M, Boeken U, Gams E, Feindt P. The use of autologous platelet gel (APG) for high-risk patients in cardiac surgery—is it beneficial?. Perfusion 2009; 24 (6) 381-387
- 20 Prziborowski J, Hartrumpf M, Stock UA, Kuehnel RU, Albes JM. Is bonewax safe and does it help?. Ann Thorac Surg 2008; 85 (3) 1002-1006