Effects of adjuvant hyperbaric oxygen therapy and real-Time fluorescent imaging on deep sternal wound infection: A retrospective study

Objective: Deep sternal wound infection (DSWI) is a rare but devastating complication that is estimated to occur in 1–2% of patients after median sternotomy. Current standard of care (SoC) comprises antibiotics, debridement and negative pressure wound therapy (NPWT). Hyperbaric oxygen therapy (HBOT) appears to be an effective adjuvant therapy for osteomyelitis. The aim of this study was to determine the effectiveness of HBOT and real‑time fluorescence imaging (RTFI) in a DSWI treatment protocol and their benefits on infection control. Method: A retrospective analysis of DSWI management was performed. Enrolled patients were divided into two groups: HBOT group and RTFI group. Patients in the HBOT group received SoC, HBOT, NPWT and reconstructive flap surgery. Patients in the RTFI group received the same therapeutic plan as well as treatment with a RTFI device (MolecuLight i:X (MolecuLight, Inc., Canada) to achieve high-quality debridement. Infection status and short-term outcomes within three months were measured. Long-term outcomes were analysed at a 12-month follow-up. Results: Of the 55 patients enrolled: 22 in the HBOT group and 33 in the RTFI group. Infection control status, evaluated in terms of white blood cell counts and C-reactive protein levels, antibiotic use duration, antibiotic costs, reinfection rate and osteomyelitis recurrence rate, were statistically significantly improved in the RTFI group (<0.001, <0.001, 0.042, 0.022, 0.049 and 0.022, respectively). Length of total intensive care unit stay and duration of complete healing were statistically significantly decreased in the RTFI group (<0.001 and 0.046, respectively). Conclusion: Patients with DSWI can benefit from HBOT, especially in terms of in-hospital mortality. RTFI can be used to eliminate bacterial burden and achieve high-quality debridement, which considerably improves infection control and clinical outcomes.