Negative-pressure sternal wound closure with interrupted subcuticular suturing and a subcutaneous drain tube reduces the incidence of poststernotomy wound infection after coronary artery bypass grafting surgery
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To retrospectively evaluate the effect of negative-pressure sternal wound closure (NPSWC) with a subcutaneous closed drain tube on the sternal surgical site infection (SSI) incidence.
After propensity score matching of 231 patients undergoing coronary artery bypass grafting (CABG), we compared 104 pairs in the NPSWC and historical control groups. In the molecular analysis, the interleukin-6 (IL-6), basic fibroblast growth factor (b-FGF), and transforming growth factor β1 (TGF-β1) levels in the wound fluid were measured using two different reservoir types at postoperative days 2 and 7.
NPSWC significantly reduced the SSI incidence from 10.6 to 2.9%. No mediastinitis occurred in the NPSWC group. A multivariate logistic regression analysis identified female sex (p = 0.0040) and no NPSWC (p = 0.0084) as significant risk factors for sternal SSI development. The Negative-pressure value was 49.4 ± 4.1 and 115.5 ± 15.2 mmHg in the standard-type (SSR) and bulb-type suction reservoirs (BSR), respectively. Given that growth factors were affected by the difference in negative pressure, the IL-6, b-FGF, and TGF-β1 levels were significantly higher in the BSR than in the SSR.
NPSWC using a subcutaneous closed drain tube was effective in preventing sternal SSI after CABG and may accelerate wound healing even when both internal thoracic arteries are harvested.
Clinical registration number
University Hospital Medical Information Network Clinical Trials Registry, registration number: UMIN000037060.
KeywordsSurgical site infection Coronary artery bypass surgery Negative-pressure sternal wound closure Subcutaneous closed drain tube
The authors wish to thank Dr. Kazutora Mizukami (Ph.D. in Statistical Science, President of Medical Data Management in Fukuoka) for the statistical assistance. They would also like to thank Editage (https://www.editage.com) for the English language editing and Ethicon for permission to use the schematic illustration.
This work was supported by the Nippon Medical School Alumni Association Medical Research Grant.
Compliance with ethical standards
Conflict of interest
There are no conflicts of interest to declare.
- 5.Dhadwal K, Al-Ruzzeh S, Athanasiou T, Choudhury M, Tekkis P, Vuddamalay P, et al. Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for sternal wound infection in high-risk patients following coronary artery bypass grafting surgery: a prospective randomised double-blind controlled trial. Heart. 2007;93:1126–33.CrossRefGoogle Scholar
- 10.Fujii M, Ochi M, Kurita J, Kambe M, Bessho R, Nitta T, Shimizu K. Prevention for surgical site infection after coronary bypass surgery. J Jpn Soc Surg Infect. 2007;4:297–301.Google Scholar
- 29.Yokoyama T, Hiyama E. Differential diagnosis between superficial incisional surgical site infection and fat necrosis. J Jpn Soc Surg Infect. 2005;2:27–9.Google Scholar