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Management of closed sternal incision after bilateral internal thoracic artery grafting with a single-use negative pressure system

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Abstract

Single-use, closed incision management (CIM) systems offer a practical means of delivering negative pressure wound therapy to patients. This prospective study evaluates the Prevena™ Therapy system in a cohort of coronary patients at high risk of deep sternal wound infection (DSWI). Fifty-three consecutive patients undergoing bilateral internal thoracic artery (BITA) grafting were preoperatively elected for CIM with the Prevena™ Therapy system, which was applied immediately after surgery. The actual rate of DSWI in these patients was compared with the expected risk of DSWI according to two scoring systems specifically created to predict either DSWI after BITA grafting (Gatti score) or major infections after cardiac surgery (Fowler score). The actual rate of DSWI was lower than the expected risk of DSWI by the Gatti score (3.8 vs. 5.8%, p = 0.047) but higher than by the Fowler score (2.3%, p = 0.069). However, while the Gatti score showed very good calibration (χ2 = 4.8, p = 0.69) and discriminatory power (area under the receiver-operating characteristic curve 0.838), the Fowler score showed discrete calibration (χ2 = 10.5, p = 0.23) and low discriminatory power (area under the receiver-operating characteristic curve 0.608). Single-use CIM systems appear to be useful to reduce the risk of DSWI after BITA grafting. More studies have to be performed to make stronger this finding.

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Authors and Affiliations

  1. Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy

    Giuseppe Gatti & Aniello Pappalardo

  2. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany

    Miroslaw Ledwon, Laszlo Gazdag, Federica Cuomo, Theodor Fischlein & Giuseppe Santarpino

  3. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy

    Giuseppe Santarpino

  4. Division of Cardiac Surgery, Ospedale di Cattinara, Via P. Valdoni, 7, 34148, Trieste, Italy

    Giuseppe Gatti

Authors
  1. Giuseppe Gatti
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  2. Miroslaw Ledwon
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  3. Laszlo Gazdag
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  4. Federica Cuomo
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  5. Aniello Pappalardo
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  6. Theodor Fischlein
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  7. Giuseppe Santarpino
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Correspondence to Giuseppe Gatti.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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The authors declare that there are no conflicts of interest.

Research involving Human Participants and/or Animals

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gatti, G., Ledwon, M., Gazdag, L. et al. Management of closed sternal incision after bilateral internal thoracic artery grafting with a single-use negative pressure system. Updates Surg 70, 545–552 (2018). https://doi.org/10.1007/s13304-018-0515-7

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  • DOI: https://doi.org/10.1007/s13304-018-0515-7

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