Negative Pressure Wound Therapy versus Conventional Treatment in Post cardiac Surgery Sternal Wound Infection

Zakaria  Elmashtoly; Hatem Aboelazayem; Haytham Yussuf

Zakaria Elmashtoly Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Hatem Aboelazayem Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Haytham Yussuf Department of Cardiothoracic Surgery, Nasr City Hospital, Cairo, Egypt

Keywords: Cardiac surgery, Negative pressure wound therapy, Mediastinitis, Deep sternal wound infection

Abstract

Background: Deep sternal wound infection (DSWI) remains a severe complication after cardiac surgery, with direct association with increased morbidity and mortality. This study evaluated the efficacy and safety of negative pressure wound therapy (NPWT) compared with conventional treatment in managing DSWI.
Methods: This randomized study included 40 patients with DSWI postcardiac surgery, which were randomly divided into NPWT (n=20) and conventional treatment (n=20) groups. Patients underwent cardiac surgery between 2019 and 2023 in a single tertiary referral center. The outcomes included wound culture clearance, C-reactive protein (CRP) reduction, complications, and hospital stay.
Results: Preoperative and operative data were comparable between both groups. During treatment, NPWT significantly reduced the percentage of positive cultures to 5% compared with 30% in the conventional group (p=0.037). C-reactive protein (CRP) levels decreased significantly in the NPWT group from 210.14 ± 41.03 mg/L to 5.5 ± 6.42 mg/L (p<0.001), whereas the conventional group presented a minimal reduction from 194.28 ± 18.95 mg/L to 176.85 ± 28.19 mg/L (p=0.125). There were notably fewer complications in the NPWT group than in the conventional group, with only 5% experiencing re-infection (p=0.018). The incidence of necrosis was also lower (5% vs. 20%, p=0.151), and the need for reoperation was lower in the NPWT group (5% vs. 20%, p=0.151). The average length of hospital stay was significantly shorter in the NPWT group (20 ± 3 days) than in the conventional group (36 ± 6 days) (p<0.001).

Conclusion: Negative pressure wound therapy is more effective than conventional treatment in managing deep sternal wound infections following cardiac surgery. NPWT significantly reduces infection rates, accelerates recovery, and minimizes complications, leading to shorter hospital stays. This study supports the use of NPWT as a preferable treatment option for DSWI.