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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2013 September;11(3):103-22
language: English, Italian
Changes in wound condition after cardiac surgery: a single-center prospective observational study
Ferrari E., La Rocca F., Forma O., De Bonis M.
IRCCS San Raffaele Hospital, Milan, Italy
Aim: Surgical wound complications after cardiac surgery are a leading cause of morbidity and mortality especially after coronary artery bypass grafting. The most common complications are: superficial and deep wound infection, dehiscence, cellulitis, lymphangitis, and chronic edema. The increased probability of infection and/or superinfection in dehiscent surgical wounds is a frequent complication in the postoperative period and may prolong the need for treatment. The aim of this paper was to assess wound healing after cardiac surgery (sternotomy/saphenectomy wounds), with a focus on immediate and late local complications in incision sites.
Methods: The study population was 95 patients observed between May and September 2011 at the San Raffaele Hospital, Milan, Department of Cardiothoracovascular Surgery, Cardiac Intensive Care, Cardiac Surgery and Cardiac Rehabilitation Services. Changes in surgical wounds were recorded on 1, 3, 5 and 10 days postsurgery. Wound conditions were inspected in 113 wounds (95 patients) on postoperative day 1, 107 wounds (92 patients) on postoperative day 3, 92 wounds (79 patients) on postoperative day 5, and 75 wounds (73 patients) on postoperative day 10. Changes in wound condition were evaluated using the Delphi method and according to more stringent criteria in a second analysis.
Results: In all, 113 wounds (95 sternal and 18 saphenectomy incision sites) were inspected. According to the Delphi method, 70.5% (95/113) of sternal and 55.6% (18/113) of saphenectomy wounds showed signs of disturbance, accounting for 68% (77/113) of all wounds. Of the 77 wounds showing an alteration, 67/77 (87%) were sternal and 10/77 (13%) were saphenectomy wounds. According to more stringent criteria, 7.4% (95/113) of sternal wounds and 22.2% (18/113) of saphenectomy wounds were altered. Overall, 9.7% of wounds showed alterations, 63.6% (11/77) of which were sternal and 36.4% (4/11) saphenectomy wounds. None of these wounds required surgical revision and healed with conventional dressings and antibiotic therapy.
Conclusion: As evaluated by the Delphi method, the incidence of postoperative wound disturbance after cardiac surgery, though not negligible, was in line with published data. While not all observed wound disturbances (erythema, edema, serous secretion, etc.) could be attributed to infection, early recognition and treatment are warranted to ensure favorable outcome. In our sample, and within the limited observation period, none of the wounds showing signs of disturbance required surgical revision, confirming that the implemented treatments were effective in controlling the changes that the study documented.