Avoiding Sternal Wire Removal in Early Onset of Sternal Site Infection: Two-Year Experience with an Optimized Treatment Concept Using Cold Atmospheric Plasma

Objectives: Surgical site infections are still a severe problem in cardiothoracic surgery. Current guidelines recommend the complete removal of implants in the infected area. A new treatment strategy using cold atmospheric plasma (CAP) and advanced negative pressure wound treatment (aNPWT), consisting of the NPWT foam and an underlay of carbon cloth, is presented as a tissue saving approach with the aim of avoiding the removal of sternal wires

Methods: Twenty patients with early onset of sternal site infection were treated with CAP and aNPWT between May 2018 and May 2020. Mean age was 69.3 years, male 65%. Previous surgery: CABG 55%, isolated valve replacement 20%, combined procedures 20%, aortic arch replacement 5%.

The most common pathogen was Staphylococcus epidermidis in 60% followed by Staphylococcus aureus (10%) and Corynebacterium (10%). Patients were included when surgical site infection occurs within the first month after cardiac surgery. Patients were included when the bone structure of the sternum was still intact at the time of the first operative debridement.

All patients received a resistance adjusted antibiotic treatment after surgical debridement. Wounds were closed by a foam with an additional underlayer of carbon cloth dressing in the meaning of advanced NPWT. The wound dressing was changed three times a week with application of cold atmospheric plasma each time.

Result: The mean time between the initial time of operation and the onset of infection was 18 days. The mean treatment time (operative debridement to wound closure) was 15 days. In most cases (n = 17) the complete sternum was treated, the upper part of the sternum was affected in only three cases. Pathogens were eradicated in 70% of the cases at the time of wound closure. A complete healing was achieved in 17 patients within the first attempt.

Two patients needed additional treatment after hospital discharge. One patient with previous history of cerebral infarction died after wound closure due to a secondary intracerebral bleeding not related to the infection or the treatment procedure.

Conclusion: An optimized treatment concept using cold atmospheric plasma and advanced NPWT may prevent the necessity of sternal wire removal. Avoiding the open chest reduces patients risk for further complication associated with deep sternal infections. This tissue saving approach might help to reduce overall costs and the length of hospital stay.

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Artikel online veröffentlicht:
19. Februar 2021