International Journal of General Medicine (Oct 2022)

Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized Controlled Trial

  • Fadaly AS,
  • Abdellatif GM,
  • Saeed SE,
  • Brik A,
  • Elsharawy M,
  • Deebis A,
  • Elfwakhry RM,
  • Shemais DS

Journal volume & issue
Vol. Volume 15
pp. 7929 – 7939

Abstract

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Ahmed S Fadaly,1 Ghada Mohammed Abdellatif,2 Sameh E Saeed,1 Alaa Brik,1 Mamdouh Elsharawy,1 Ahmed Deebis,1 Rabab Mahmoud Elfwakhry,3 Dina Said Shemais1 1Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 2Department of Pediatric medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 3Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Dina Said Shemais, Department of cardiothoracic surgery, Zagazig University, Zagazig, 44631, Egypt, Tel +201090726390, Email [email protected]: To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group.Materials and Methods: A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival.Results: The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55± 3.57 and it was 32.61± 8.39 showing high statistically significant difference (p< 0.001). Patients in the primary closure group had earlier discharge from hospital 15.77± 4.18 than vacuum assisted group 42.61± 8.39, with high statistically significant difference (p< 0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up.Conclusion: Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.Keywords: pediatric mediastinitis, post-cardiac surgery, primary closure, vacuum-assisted closure, interrupted mattress wires

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