Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson PA-C, MPH

Second Advisor

Annjanette Sommers MS, PAC

Third Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Poststernotomy mediastinitis (PM) is a rare but often fatal complication of surgeries that involve median sternotomy. Although incidence has been reported from 0.4-5%, mortality rates reported from 10-47% make this a potentially devastating complication. Initial treatment for mediastinitis includes administration of antibiotics, surgical debridement of infected tissues, and removal of sternal wires. After debridement, conventional treatment consists of reclosure of the sternum with or without closed irrigation, and surgery using omentum or muscle flap to correct tissue defects when needed. More recently, negative pressure wound therapy is becoming increasingly used as a method of treatment for mediastinitis. This review was performed to evaluate the effectiveness of negative pressure wound therapy versus conventional treatment of mediastinitis.

Methods: An exhaustive literature search using Ovid-Medline, CINAHL, and ISI Web of Science was conducted with the search terms: Negative pressure wound therapy, vacuum-assisted closure, mediastinitis, deep sternal wound infection (DSWI), surgical wound infection, sternum, wound vac, and sternotomy. Key words and subsidiary MeSH terms were selected where appropriate and where permitted by the search engine. The focus of this review was to assess the current literature for the last 10 years on all studies pertaining to the use of negative pressure wound therapy (NPWT) versus conventional treatment for poststernotomy mediastinitis.

Results: Four articles meeting search criteria were found and reviewed. The four studies reviewed included data on mortality, duration of treatment, length of hospitalization, and reinfection rates. Two of the reviewed studies showed significant reduction in mortality in the NPWT cohort. Three of the four studies looked at reinfection rate and all three showed a significant reduction in the NPWT group. All four studies looked at length of hospital stay after induction of PM treatment and only one showed a significant reduction in the NPWT group. No significant difference in treatment duration was seen between the cohorts.

Conclusion: Negative pressure wound therapy reduces reinfection rate during treatment of poststernotomy mediastinitis, and can reduce mortality and length of hospital stay associated with the infection.

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