The Egyptian Cardiothoracic Surgeon

Early and Mid-Term Outcomes of Quadruple Attack Technique for Sternal Osteomyelitis and Chronic Sinus Formation After Cardiac Surgery

2026-05-14T10:27:34+02:00

Background: Sternal osteomyelitis with chronic sinus tract after cardiac surgery is a serious complication, and early management is crucial. The aim of this study is to report our experience with the “Quadruple Attack” technique, which involves intravenous (IV) antibiotics, surgical debridement, vacuum therapy, and hyperbaric oxygen sessions for management of this condition.

Methods: This prospective study was performed at Cardiothoracic Surgery Department, Ain Shams University in Egypt between March 2020 and August 2024 and included 52 patients who underwent the quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract.

Results: The mean age was 49.6 ± 9.23 years. 12 (23.1%) patients were hypertensive, while 17 (32.7%) of patients had diabetes. 44 (84.6%) of patients had satisfactory healing, 8 patients (15.4%) had re-sternotomy and resection of the sinus tract, while 5 patients (9.6%) required sternectomy and musculocutaneous flaps.

Conclusion: Our quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract after cardiac surgery is promising, with encouraging mid-term outcomes in selected patients with a non-dehisced sternum.

Comparison Between the Impact of Antegrade Versus Retrograde Arterial Cannulation Techniques on the Early Outcome of Patients with Type A Aortic Dissection

2026-05-14T10:27:34+02:00

Background: Acute type A aortic dissection represents one of the most critical emergencies in cardiovascular surgery, demanding rapid diagnosis and prompt operative intervention. Despite significant advances in surgical strategies and perioperative management, morbidity and mortality remain high, and the choice of cannulation technique continues to generate debate among surgeons worldwide.

Methods: It is a prospective non randomized comparative study aimed to compare the early outcome of repair of type A aortic dissection using different cannulation techniques by sorting them into two groups, Group 1, The antegrade group (30 patients) in which axillary, innominate and central cannulation was done and Group 2, the retrograde group (30 patients) in which femoral cannulation was done from March 2021 till September 2025.

Results: The mean age was 56.2 ± 11.4 for group 1 and 58.6 ± 10.7 for group 2. The in-hospital mortality was 2 patients (6.7%) in the antegrade group versus 5 patients (16.7%) in the retrograde group while the 30-day mortality was 3 patients (10%) in the antegrade group versus 6 patients (20%) in the retrograde group.

Conclusion: Antegrade and retrograde cannulation both remain safe and effective strategies in managing acute type A aortic dissection. Antegrade approaches showed meaningful advantages in procedural efficiency, cerebral protection, and recovery outcomes. When pathology and surgical expertise permit, antegrade cannulation should be favored. while retrograde access remains a reliable option in emergency cases.

Outcome of Bilateral Thoracoscopic Sympathectomy for Patients with Primary Focal Hyperhidrosis, Sohag University Hospital Experience

2026-05-14T10:27:34+02:00

Background: Primary focal hyperhidrosis (PFH) causes excessive sweating and significant quality-of-life impairment, with symptoms aggravated by emotional stress and anxiety. Conservative treatments often provide only temporary relief, making endoscopic thoracic sympathectomy (ETS) the definitive option, though traditional T2 interruption carries a high risk of compensatory sweating. Lower T3–T4 interruption may reduce this complication, but regional data are lacking. This study assesses the efficacy and safety of T3–T4 bilateral thoracoscopic sympathectomy in Egyptian patients.

Methods: This prospective study included 20 patients (≥16 years) with severe PFH (HDSS ≥3) unresponsive to conservative therapy, excluding those with severe cardiopulmonary disease or bleeding disorders. Diagnosis was confirmed clinically and with Minor starch–iodine testing. All patients underwent bilateral thoracoscopic T3–T4 sympathicotomy. Outcomes included symptom resolution, compensatory sweating, QoL (DLQI), complications, and recurrence, with follow-up up to 6 months.

Results: Twenty patients (mean age 20.9 years; 65% male) with severe PFH underwent bilateral thoracoscopic T3–T4 sympathectomy. All procedures were completed safely with minimal blood loss and rapid recovery. HDSS scores dropped from a median of 4 to 0 (p < 0.001), with high patient satisfaction (median 10/10). Compensatory sweating occurred in 15% (mild/moderate), and one patient (5%) had recurrence. Functional and occupational outcomes improved in nearly all patients, sustained at a mean follow-up of 8.6 months.

Conclusion: T3–T4 bilateral thoracoscopic sympathectomy is a safe, effective surgical option for severe PFH. It produces excellent symptom control, minimal morbidity, high patient satisfaction, and acceptable levels of compensatory sweating. With continued refinement of technique and patient selection, T3–T4 BTS can be considered a reproducible standard of care in resource-constrained settings.