Nanotechnology has opened a new area of scientific research. This field deals with materials within the dimensions of 1–100nm and a plethora of new technologies have emerged. In wound care, silver nanoparticles are used to aid wound healing as an antimicrobial agent, but also as an anti-inflammatory agent. The properties of silver nanoparticles differ from that of the material on a larger scale and their production can be controlled to give varied properties and characteristics that have different uses. These resultant properties are very important and differences in characterisation can alter their biological and physical attributes. All wound dressings have to undergo rigorous scrutiny around toxicity and safety when regulatory review is undertaken, yet some users still have concerns over long-term effects of silver nanoparticles in vivo. This review will address some of these concerns and reviews the current health and safety data associated with introduction of new products containing silver nanoparticles using Venus Ag dressings (SFM LTD, UK) as an example.

KEY WORDS   Nanoparticles of silver   Safety   Silver dressings   Toxicity

VAL EDWARDS-JONES PhD,CSci, FIBMS, Independent Microbiology Consultant, Essential Microbiology Limited

There were an estimated 3.8 million patients with a wound managed by the NHS in 2017/2018 at a cost of £8.3 billion (Guest et al, 2017). The cost to the patient and their quality of life is immense. Evidence has shown that there are wide variations in the care of people with chronic wounds, with many patients not receiving the correct assessment or a diagnosis on which to base decisions about their care (Guest et al, 2015; Gray et al, 2018). Delivering efficient and effective care to patients with a venous leg ulcer (VLU) requires collaborative working across specialist and community settings to tackle inequalities in care, improve outcomes, enhance productivity, and provide value for money.

KEY WORDS   Venous leg ulcer   Compression Reducing variation  UrgoKTwo  DR CAROLINE DOWSETT  Clinical Nurse Specialist  Tissue  Viability, East London   NHS  Foundation Trust; Independent   Nurse Consultant

ABSTRACT: Biofilm formation in wounds contributes greatly to the lack of healing and increased healthcare expenditures. Antimicrobial efficacy is decreased significantly in the presence of biofilms, which can, in turn, promote the development of antibiotic resistance. Antibiofilm strategies to prevent the formation and persistence of biofilm in wounds would consequently decrease the incidence of chronic wounds and improve wound healing. The use of preclinical biofilm models to assess the antibiofilm efficacy of wound dressings is a prerequisite to identifying new technologies that can improve outcomes in hardto-heal wounds. Improvements to preclinical approaches (in vitro and in vivo) to biofilm models are needed. Living tissue (ex vivo) derived from pig and human skin donors is a developing approach that translates the research to the clinic, including the native microenvironment of the biofilm.

KEY WORDS Bacteria   Biofilm   Infection   Microbiology   Swab   Wound dressings

MARNIE PETERSON PharmD, PhD, Site Director, Perfectus Biomed Group, Now Part of NAMSA, 3545 South Park Dr., Jackson, Wyoming, 83001, US. 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

SAM WESTGATE PhD, Executive Director,  Perfectus Biomed Group, Now Part of NAMSA, Techspace One SciTech Daresbury, Keckwick Lane, Daresbury, Cheshire, WA4 4AB, UK, 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Raghda Basil Ismael Alkhateeb1, Asmaa Saleem Esmail Ah-Ghurabi2,

Laith Saleh Alkaaby3, Abdulsalam Y. Taha4

1 Department of Cardiac Surgery, Slemani Cardiac Hospital, Sulaymaniyah, Iraq

2 The Diabetes Center in Sulaymaniyah, Sulaymaniyah, Iraq

3 Department of Cardiac Surgery, Iraqi Center for Heart Diseases, Baghdad, Iraq

4 Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq

Email： ansthasia＿该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

How to cite this paper: Alkhateeb, R.B.I., Ah-Ghurabi, A.S.E., Alkaaby, L.S. and Taha, A.Y. (2022) Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq. World Journal of Cardiovascular Surgery, 12, 153-172. https://doi.org/10.4236/wjcs.2022.127012

Received: April 24, 2022

Accepted: July 26, 2022

Published: July 29, 2022

Copyright © 2022 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/

Abstract

      Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2 . There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.

Keywords

      Deep Sternal Wound Infection, Mediastinitis, Coronary Artery Bypass Grafting, Median Sternotomy, Vacuum-Assisted Closure, Wound Debridement