Dermacyn® Irrigation in Reducing Infection of a Median Sternotomy Wound
DOI:
https://doi.org/10.1532/HSF98.20091162Abstract
Background: Sternal wound infection is an infrequent yet potentially devastating complication following sternotomy. Among the standard practices used as preventive measures are the use of prophylactic antibiotics and povidone-iodine as an irrigation agent. A new antiseptic agent, Dermacyn® super-oxidized water (Oculus Innovative Sciences), has recently been used as a wound-irrigation agent before the closure of sternotomy wounds.
Methods: This prospective, randomized clinical trial was conducted to compare the effectiveness of Dermacyn and povidone-iodine in reducing sternotomy wound infection in patients undergoing coronary artery bypass graft surgery. Upon chest closure and after insertion of sternal wires, wounds were soaked for 15 minutes with either Dermacyn or povidone-iodine. Subcutaneous tissue and skin were then closed routinely. Patients were followed up, and any wound infection was analyzed.
Results: Of the 178 patients, 88 patients were in the Dermacyn group, and 90 were in the povidone-iodine group. The mean (±SD) age of the patients was 61.1 ± 7.6 years. The incidence of sternotomy wound infection was 19 cases (10.7%). Five (5.7%) of these cases were from the Dermacyn group, and 14 (15.6%) were from the povidone-iodine group (P = .033). No Dermacyn-related complication was identified.
Conclusion: We found Dermacyn to be safe and more effective as a wound-irrigation agent than povidone-iodine for preventing sternotomy wound infection.
References
Bitkover CY, Gårdlund B. 1998. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 65:36-40.nBlanchard A, Hurni M, Ruchat P, Stumpe F, Fischer A, Sadeghi H. 1995. Incidence of deep and superficial sternal infection after open heart surgery. A ten years retrospective study from 1981 to 1991. Eur J Cardiothorac Surg 9:153-7.nBongiovanni CM. 2006. Superoxidized water improves wound care outcomes in diabetic patients. Diabet Microvasc Complications Today May/June:11-4.nCarrier M, Grégoire J, Tronc F, Cartier R, Leclerc Y, Pelletier LC. 1992. Effect of internal mammary artery dissection on sternal vascularization. Ann Thorac Surg 53:115-9.nEl Oakley RM, Wright JE. 1996. Postoperative mediastinitis: classification and management. Ann Thorac Surg 61:1030-6.nGrossi EA, Esposito R, Harris LJ, et al. 1991. Sternal wound infections and use of internal mammary artery grafts. J Thorac Cardiovasc Surg 102:342-6.nHirotani T, Shirota S, Cho Y, Takeuchi S. 2002. Feasibility and suitability of the routine use of bilateral internal thoracic arteries. Ann Thorac Surg 73:511-5.nHoran FC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. 1992. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606-8.nLanda-Solis C, González-Espinosa D, Guzmán-Soriano B, et al. 2005. Microcyn: a novel super-oxidized water with neutral pH and disinfectant activity. J Hosp Infect 61:291-9.nLoop FD, Lytle BW, Cosgrove DM, et al. 1990. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 49:179-87.nMoulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. 1996. Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 94(suppl):II87-92.nOculus Innovative Sciences. 2006. Technical description of DERMA-CYN™. Microcyn™ Technology, Inc. Petaluma, Calif.: Oculus Innovative Sciences.nOhno H, Higashidate M, Yokosuka T. 2000. Mediastinal irrigation with superoxidized water in open-heart surgery: the safety and pitfalls of cardiovascular surgical application. Surg Today 30:1055-6.nOschner JL, Mills NL, Woolverton WC. 1972. Disruption and infection of median sternotomy incision. J Cardiovasc Surg 13:394-9.nPaola LD, Brocco E, Senesiet A, et al. 2006. Super-oxidized solution (SOS) therapy for infected diabetic foot ulcers. Wounds 18:262-70.nSofer D, Gurevitch J, Shapira I, et al. 1999. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Ann Surg 229:585-90.nUlicny KS Jr, Hiratzka LF. 1991. The risk factors of median sternotomy infection: a current review. J Card Surg 6:338-51.nVegas AA, Jodra VM, García ML. 1993. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and directs cost of hospitalization. Eur J Epidemiol 9:504-10.nZacharias A, Habib RH. 1996. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest 110:1173-8.n
