120ULTRASOUND-ASSISTED TREATMENT OF STERNOCUTANEOUS FISTULA IN POSTSTERNOTOMY CARDIAC SURGERY PATIENTS

Objectives: Using an ultrasonic debridement system, we aimed at complete removal of bacterial biofilms and preservation of vital sternal tissue, and compared the procedure to conventional surgical therapy. Methods: In this retrospective study, we evaluated 37 consecutive patients (25 male) between April 2011 and June 2013, in whom sternocutaneous fistula (SCF) was treated with the ultrasound-assisted wound system (UAW, group A, n = 18) or with conventional surgical therapy (group B, n = 19). Treatment in group A consisted of complete dissection of SCF followed by a multistep UAW debridement session. Our final step in both groups was secondary wound closure with a musculocutaneous flap. Results: Most patients were categorised as high risk, presenting with several of the known risk factors. In both groups, a similar variety of microorganisms were isolated: 61% of Gram-positive, 16.5% Gram-negative species and 10.5% Candida albicans were detected. Time to eradication and secondary wound closure was significantly shorter in group A (9.8 ± 5.4 vs 12.2 ± 17.2 days, P = 0.0118). Postoperative antibiotic treatment time (16.4 ± 9.3 vs 22.4 ± 10.7 days, P = 0.0779) showed a trend in favour of group A, mean hospitalisation time (22.2 ± 12.0 vs 26.4 ± 14.3 days, P = 0.3412) did not differ between groups. Recurrence of SCF tended to be lower in group A (5.5% vs 21% in group B, P = 0.3398). In group B, one infection-related death was noted. Mean follow-up time was 7.7 ± 2.7 (A) and 9.8 ± 5.7 months (B). Conclusion: Ultrasonic debridement is a promising adjunct to SCF treatment. In combination with adequate surgical and antimicrobial therapy, we documented good mid-term results in our trial group.