The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Richard Ingemansson - One of the best experts on this subject based on the ideXlab platform.
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poststernotomy Mediastinitis a review of conventional surgical treatments vacuum assisted closure therapy and presentation of the lund university hospital Mediastinitis algorithm
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Poststernotomy Mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery. The overall incidence of poststernotomy Mediastinitis is relatively low, between 1% and 3%, however, this complication is associated with a significant mortality, usually reported to vary between 10% and 25%. At the present time, there is no general consensus regarding the appropriate surgical approach to Mediastinitis following open-heart surgery and a wide range of wound-healing strategies have been established for the treatment of poststernotomy Mediastinitis during the era of modern cardiac surgery. Conventional forms of treatment usually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Unfortunately, procedure-related morbidity is relatively frequent when using conventional treatments and the long-term clinical outcome has been unsatisfying. Vacuum-assisted closure is a novel treatment with an ingenious mechanism. This wound-healing technique is based on the application of local negative pressure to a wound. During the application of negative pressure to a sternal wound several advantageous features from conventional surgical treatment are combined. Recent publications have demonstrated encouraging clinical results, however, observations are still rather limited and the underlying mechanisms are largely unknown. This review provides an overview of the etiology and common risk factors for deep sternal wound infections and presents the historical development of conventional therapies. We also discuss the current experiences with VAC therapy in poststernotomy Mediastinitis and summarize the current knowledge on the mechanisms by which VAC therapy promotes wound healing. Finally, we suggest a structured algorithm for using VAC therapy for treatment of poststernotomy Mediastinitis in clinical practice.
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the impact of vacuum assisted closure on long term survival after post sternotomy Mediastinitis
The Annals of Thoracic Surgery, 2005Co-Authors: Johan Sjogren, Johan Nilsson, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Background Post-sternotomy Mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after vacuum-assisted closure treated Mediastinitis following coronary artery bypass grafting with that of patients without Mediastinitis. Another objective was to identify risk factors for developing Mediastinitis. Methods Forty-six patients were treated for Mediastinitis, with vacuum-assisted closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without Mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for Mediastinitis. Results There was no difference in early or late survival between the Mediastinitis group treated with vacuum-assisted closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the vacuum-assisted closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing Mediastinitis. Conclusions This study suggests that patients with vacuum-assisted closure treated Mediastinitis may have similar long-term survival as patients without Mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that vacuum-assisted closure therapy minimizes the negative effects of Mediastinitis on late survival after coronary artery bypass grafting.
Johan Sjogren - One of the best experts on this subject based on the ideXlab platform.
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poststernotomy Mediastinitis a review of conventional surgical treatments vacuum assisted closure therapy and presentation of the lund university hospital Mediastinitis algorithm
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Poststernotomy Mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery. The overall incidence of poststernotomy Mediastinitis is relatively low, between 1% and 3%, however, this complication is associated with a significant mortality, usually reported to vary between 10% and 25%. At the present time, there is no general consensus regarding the appropriate surgical approach to Mediastinitis following open-heart surgery and a wide range of wound-healing strategies have been established for the treatment of poststernotomy Mediastinitis during the era of modern cardiac surgery. Conventional forms of treatment usually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Unfortunately, procedure-related morbidity is relatively frequent when using conventional treatments and the long-term clinical outcome has been unsatisfying. Vacuum-assisted closure is a novel treatment with an ingenious mechanism. This wound-healing technique is based on the application of local negative pressure to a wound. During the application of negative pressure to a sternal wound several advantageous features from conventional surgical treatment are combined. Recent publications have demonstrated encouraging clinical results, however, observations are still rather limited and the underlying mechanisms are largely unknown. This review provides an overview of the etiology and common risk factors for deep sternal wound infections and presents the historical development of conventional therapies. We also discuss the current experiences with VAC therapy in poststernotomy Mediastinitis and summarize the current knowledge on the mechanisms by which VAC therapy promotes wound healing. Finally, we suggest a structured algorithm for using VAC therapy for treatment of poststernotomy Mediastinitis in clinical practice.
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the impact of vacuum assisted closure on long term survival after post sternotomy Mediastinitis
The Annals of Thoracic Surgery, 2005Co-Authors: Johan Sjogren, Johan Nilsson, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Background Post-sternotomy Mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after vacuum-assisted closure treated Mediastinitis following coronary artery bypass grafting with that of patients without Mediastinitis. Another objective was to identify risk factors for developing Mediastinitis. Methods Forty-six patients were treated for Mediastinitis, with vacuum-assisted closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without Mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for Mediastinitis. Results There was no difference in early or late survival between the Mediastinitis group treated with vacuum-assisted closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the vacuum-assisted closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing Mediastinitis. Conclusions This study suggests that patients with vacuum-assisted closure treated Mediastinitis may have similar long-term survival as patients without Mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that vacuum-assisted closure therapy minimizes the negative effects of Mediastinitis on late survival after coronary artery bypass grafting.
Malin Malmsjo - One of the best experts on this subject based on the ideXlab platform.
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poststernotomy Mediastinitis a review of conventional surgical treatments vacuum assisted closure therapy and presentation of the lund university hospital Mediastinitis algorithm
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Poststernotomy Mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery. The overall incidence of poststernotomy Mediastinitis is relatively low, between 1% and 3%, however, this complication is associated with a significant mortality, usually reported to vary between 10% and 25%. At the present time, there is no general consensus regarding the appropriate surgical approach to Mediastinitis following open-heart surgery and a wide range of wound-healing strategies have been established for the treatment of poststernotomy Mediastinitis during the era of modern cardiac surgery. Conventional forms of treatment usually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Unfortunately, procedure-related morbidity is relatively frequent when using conventional treatments and the long-term clinical outcome has been unsatisfying. Vacuum-assisted closure is a novel treatment with an ingenious mechanism. This wound-healing technique is based on the application of local negative pressure to a wound. During the application of negative pressure to a sternal wound several advantageous features from conventional surgical treatment are combined. Recent publications have demonstrated encouraging clinical results, however, observations are still rather limited and the underlying mechanisms are largely unknown. This review provides an overview of the etiology and common risk factors for deep sternal wound infections and presents the historical development of conventional therapies. We also discuss the current experiences with VAC therapy in poststernotomy Mediastinitis and summarize the current knowledge on the mechanisms by which VAC therapy promotes wound healing. Finally, we suggest a structured algorithm for using VAC therapy for treatment of poststernotomy Mediastinitis in clinical practice.
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the impact of vacuum assisted closure on long term survival after post sternotomy Mediastinitis
The Annals of Thoracic Surgery, 2005Co-Authors: Johan Sjogren, Johan Nilsson, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Background Post-sternotomy Mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after vacuum-assisted closure treated Mediastinitis following coronary artery bypass grafting with that of patients without Mediastinitis. Another objective was to identify risk factors for developing Mediastinitis. Methods Forty-six patients were treated for Mediastinitis, with vacuum-assisted closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without Mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for Mediastinitis. Results There was no difference in early or late survival between the Mediastinitis group treated with vacuum-assisted closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the vacuum-assisted closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing Mediastinitis. Conclusions This study suggests that patients with vacuum-assisted closure treated Mediastinitis may have similar long-term survival as patients without Mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that vacuum-assisted closure therapy minimizes the negative effects of Mediastinitis on late survival after coronary artery bypass grafting.
Ronny Gustafsson - One of the best experts on this subject based on the ideXlab platform.
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poststernotomy Mediastinitis a review of conventional surgical treatments vacuum assisted closure therapy and presentation of the lund university hospital Mediastinitis algorithm
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Johan Sjogren, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Poststernotomy Mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery. The overall incidence of poststernotomy Mediastinitis is relatively low, between 1% and 3%, however, this complication is associated with a significant mortality, usually reported to vary between 10% and 25%. At the present time, there is no general consensus regarding the appropriate surgical approach to Mediastinitis following open-heart surgery and a wide range of wound-healing strategies have been established for the treatment of poststernotomy Mediastinitis during the era of modern cardiac surgery. Conventional forms of treatment usually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Unfortunately, procedure-related morbidity is relatively frequent when using conventional treatments and the long-term clinical outcome has been unsatisfying. Vacuum-assisted closure is a novel treatment with an ingenious mechanism. This wound-healing technique is based on the application of local negative pressure to a wound. During the application of negative pressure to a sternal wound several advantageous features from conventional surgical treatment are combined. Recent publications have demonstrated encouraging clinical results, however, observations are still rather limited and the underlying mechanisms are largely unknown. This review provides an overview of the etiology and common risk factors for deep sternal wound infections and presents the historical development of conventional therapies. We also discuss the current experiences with VAC therapy in poststernotomy Mediastinitis and summarize the current knowledge on the mechanisms by which VAC therapy promotes wound healing. Finally, we suggest a structured algorithm for using VAC therapy for treatment of poststernotomy Mediastinitis in clinical practice.
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the impact of vacuum assisted closure on long term survival after post sternotomy Mediastinitis
The Annals of Thoracic Surgery, 2005Co-Authors: Johan Sjogren, Johan Nilsson, Ronny Gustafsson, Malin Malmsjo, Richard IngemanssonAbstract:Background Post-sternotomy Mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after vacuum-assisted closure treated Mediastinitis following coronary artery bypass grafting with that of patients without Mediastinitis. Another objective was to identify risk factors for developing Mediastinitis. Methods Forty-six patients were treated for Mediastinitis, with vacuum-assisted closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without Mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for Mediastinitis. Results There was no difference in early or late survival between the Mediastinitis group treated with vacuum-assisted closure and the control group ( p = not significant). The survival at 1, 3, and 5 years was 92.9% ± 4.0%, 89.2% ± 5.2%, and 89.2% ± 5.2%, respectively, in the vacuum-assisted closure group; and 96.5% ± 0.3%, 92.1% ± 0.5%, and 86.9% ± 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing Mediastinitis. Conclusions This study suggests that patients with vacuum-assisted closure treated Mediastinitis may have similar long-term survival as patients without Mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that vacuum-assisted closure therapy minimizes the negative effects of Mediastinitis on late survival after coronary artery bypass grafting.
Yasuo Morishita - One of the best experts on this subject based on the ideXlab platform.
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successful video assisted mediastinoscopic drainage of descending necrotizing Mediastinitis
The Annals of Thoracic Surgery, 2006Co-Authors: Kimihiro Shimizu, Yoshimi Otani, Tetuhiro Nakano, Yukihiro Takayasu, Yoshihito Yasuoka, Yasuo MorishitaAbstract:Descending necrotizing Mediastinitis is an uncommon form of Mediastinitis that can rapidly progress to septacemia. To date, the optimal surgical approach has remained controversial. We report a case of descending necrotizing Mediastinitis that was treated successfully through a transcervical approach with video-assisted mediastinoscopy. In our case, because the abscess was separated into small compartments, especially in the paratracheal space, the abscess was drained using video-assisted mediastinoscopy. This less-invasive approach may be an option in the treatment of descending necrotizing Mediastinitis, especially when the abscess in the paratracheal space is separated into small compartments.