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Objective To review our management of chest incision after delayed sternal closure for complex congenital heart defect surgery in neonatal patients and to evaluate the outcomes of the individualized nursing strategies. Methods According to the classification of chest incision, individualized strategies were applied in 112 neonates who underwent subsequent delayed sternal closure.Before the chest closure,Huihanshutai (a kind of biomedical colloid dispersant with content of silver ions)was used to address the incision in case of no wound infection,and in case of infections,URGOSORB was used.After delayed sternal closure,silver ion was used to cover a healthy wound.Wound drainage combined with Huihanshutai was required in the wound with mild inflammation.If there was a severely-infected wound,we kept the principle of wound wet healing. Result There was no death or bacteremia owing to the wound infection in this cohort of patients(n=112). Conclusions Individualized nursing management of the wound after delayed sternal closure based on the classification of wound and principle of wound wet healing can achieve acceptable outcomes.Appropriate adoption of silver ions and URGOSORB is crucial to improve the wound healing and protect the wounds from infection.
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@#Objective To investigate the application of delayed sternal closure (DSC) following arterial switch operation for neonates with transposition of great arteries (D-TGA). Methods We retrospectively analyzed clinical data of 172 neonates underwent arterial switch operation with transposition of great arteries (D-TGA) between June 1st 2009 and December 31st 2015. These neonates were divided into 2 groups including a DSC group (118 patients with 99 males and 19 females) and a non-DSC group (54 patients with 47 males and 7 females). The outcome of the two groups were compared. Results Preoperative mechanical ventilation(P<0.001), emergency surgery (P=0.023) and extracorporeal circulation time (P<0.001) were the risk factors for delayed sternal closure. The incidence of complications of median sternotomy incision in the DSC group was not higher than that in the non-DSC group. The mortality rate in the DSC group was markedly higher than that in the non-DSC group (P<0.001). However, DSC was not a risk factor for the death of the neonates. Conclusion Delayed sternal closure does not increase the incidence of complications of the median sternotomy incision, nor is it a risk factor for the death of the neonates. Reasonable application of delayed sternal closure is helpful for early postoperative recovery of the neonates.
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Introduction: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. Aim: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. Methodology: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant. Results: 58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40). Conclusion: The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.
Introducción: Las infecciones del sitio quirúrgico (ISQ) son importante causa de morbilidad en cirugía cardíaca pediátrica. Los factores de riesgo en pacientes que requieren cierre esternal diferido (CED) se desconocen. Objetivos: Reportar la tasa de ISQ en niños sometidos a cirugía cardíaca con CED y determinar factores de riesgo de ISQ. Metodología: Estudio retrospectivo de casos y controles en pacientes bajo 15 años de edad, sometidos a cirugía cardíaca con CED, en los años 2009 y 2010. Se consideró casos aquellos con ISQ diagnosticada según criterios del comité de IAAS local. Se realizó análisis uni y multivariado de las variables. Se consideró significativo un p < 0,05. Resultados: Se incluyeron 58 pacientes; la mediana de edad fue 9,5 días. Diagnósticos más frecuentes fueron transposición de grandes arterias (36%) e hipoplasia de ventrículo izquierdo (27%). Trece pacientes presentaron ISQ (22%); 11 incisionales y 2 me-diastinitis. Se asociaron de manera independiente a ISQ: circulación extracorpórea (CEC) mayor a 200 min (OR ajustado = 9,53; IC 95% 1,37-66,35) y ventilación mecánica invasora (VMI) más de 5 días (OR ajustado = 8,98; IC 95% 1,16-69,40). Conclusión: La duración de CEC y VMI son factores de riesgo de ISQ en niños sometidos a cirugía cardíaca con CED.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Surgical Wound Infection/prevention & control , Surgical Wound Infection/epidemiology , Sternotomy/adverse effects , Heart Defects, Congenital/surgery , Cardiac Surgical Procedures/adverse effects , Case-Control Studies , Retrospective Studies , Risk Factors , Cardiac Surgical Procedures/methodsABSTRACT
Objective To investigate the application of delayed sternal closure (DSC) following neonatal cardiac surgery.Methods We retrospectively analyzed clinical data of 360 neonatal patients underwent cardiac surgery through median sternotomy in Guangdong General Hospital between June 2009 and June 2014.These neonates were divided into 2 groups:DSC group (190 cases) and non-DSC group(170 cases).Comparing the differences between 2 groups,we analysed the application of DSC following neonatal cardiac surgery and the effect of DSC on surgical site infection.Results The cardiopulmonary bypass time,cross clamp time and mechanical ventilation time were longer in DSC group than in non-DSC group.The mortality rate in the DSC group(20.53％) was markedly higher than that in the non-DSC group(5.29％).However,there was no statistical difference in the incidence of sternal wound infection between 2 groups.Conclusion As an effective treatment for neonates with severe cardiac surgery,DSC doesn' t increase the incidence of surgical site infection.
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Objective To investigate the application of delayed sternal closure in the process of open heart surgery.Methods Delayed sternal closure was performed from Mar.2000 to Jun.2005 in 11 patients(4 males and 7 females,aged 16-67 years with an average of 42 years) after cardiac surgery.The indication included: cardiac dilatation(4 cases),intractable arrhythmia(4 cases),continuous bleeding(2 cases) and severe pulmonary edema(1 case).During the open chest period,the wound was covered with 3-layers of latex temporarily,and the delayed sternal closure was performed when bleeding was controlled,heart size reduced,and hemodynamic condition became stable.Results Except two patients died of acute kidney failure during open chest period,delayed sternal closure was successfully carried out in 9 patients 8-43 hours(23.7?11.0) after cardiac surgery.Except one patient died of cardiac arrest 21 days after operation,the 8 others survived and were discharged from ICU 1-8 days(3.9?2.4) after sternal closure,and the wounds healed well.Follow-up for the 8 survivors revealed an improvement of NYHA class(class Ⅰfor 4 cases,class Ⅱfor 2 cases,and class Ⅲ for 2 cases).Conclusion The delayed sternal closure is an effective method in the treatment of postoperative cardiac compression,severe bleeding and arrhythmia,and it does not increase the incidence of complications such as sternal infection.