Tissue Saving: Plasma-Based Treatment Concept for Sternal Infection Including One-Year Follow-up

Background: Deep sternal infection is still a life threatening complication following cardiac surgery. Current guidelines recommend radical debridement of the infected area with removal of the sternal wires and partial or complete resection of the sternum.

Most of these patients are in need for plastic surgery afterwards. However short- and long-term results of this radical approach with regard to mortality—up to only 50% one-year survival rate reported in retrospective studies—and quality of life remain unsatisfactory.

A tissue saving approach—avoiding sternal resection—using cold atmospheric plasma (CAP) and advanced negative pressure therapy (aNPWT) has already proven its ability in the management of sternal infection.

Method: Retrospective data analysis of our own patient population. Inclusion criteria: patients who developed a sternal infection after cardiac surgery between August 2019 and July 2021 (2 years). One-year follow-up after wound closure was examined to assess the long-term course regarding chest wall stability and overall survival. Forty-four patients (30 males/14 females) were included and were treated with a plasma-based protocol. Thirty-six patients were treated with cold atmospheric plasma in combination with aNPWT, 8 patients were treated only with cold atmospheric plasma and a standard dressing.

Results: The most frequently detected pathogens were staphylococci (57%). Average number of surgical interventions required was 2.3. Median treatment time (debridement to wound closure) was 14 days. An additional follow-up treatment was required for 10 patients (22.7%). Following the tissue saving protocol sternal resection could be avoided in all 44 patients. To regain sternal stability 8 patients (18%) received sternal plates in the formerly infected sternal area.

Conclusion: The retrospective data analysis shows a one year survival of 86.4% (38/44). In all patients sternal resection could be avoided and chest wall stability was maintained. Compared with the recommendations of the current guidelines the tissue saving treatment concept enables a reduction in the number of necessary surgical interventions and length of hospital stay.

Publication History

Article published online:
28 January 2023