{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:26:25Z","timestamp":1790011585613,"version":"4.0.1"},"reference-count":96,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medicinal Research Reviews"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue\/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram\u2010negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.<\/jats:p>","DOI":"10.1002\/med.21758","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T12:08:41Z","timestamp":1605096521000},"page":"709-724","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing"],"prefix":"10.1002","volume":"41","author":[{"given":"Aathira","family":"Pradeep","sequence":"first","affiliation":[{"name":"Centre for Nanosciences and Molecular Medicine Amrita Vishwa Vidyapeetham  Kochi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0066-4208","authenticated-orcid":false,"given":"Jayakumar","family":"Rangasamy","sequence":"additional","affiliation":[{"name":"Centre for Nanosciences and Molecular Medicine Amrita Vishwa Vidyapeetham  Kochi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen Kerala","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre Amrita Vishwa Vidyapeetham  Kochi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmcts\/mmv017"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885328213495426"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.07.005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-017-0656-7"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-019-1000-1"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2018.05.026"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2019.01.008"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(97)01339-8"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.14194\/ijmbr.123"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(02)00084-2"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.09.019"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(01)00991-5"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S130172"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(95)01035-1"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(98)00063-0"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.01.060"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)04556-3"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0139122"},{"key":"e_1_2_8_20_1","first-page":"21","article-title":"Gentamicin\u2010impregnated collagen sponge for preventing sternal wound infection after cardiac surgery","volume":"11","author":"Koziot M","year":"2014","journal-title":"Kardiochir Torakochirurgia Pol"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.09.046"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(99)00014-7"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(02)00124-0"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.03.015"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2000-9945"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1038470"},{"key":"e_1_2_8_27_1","first-page":"536","article-title":"The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: the role of skeletonization","volume":"129","author":"De Paulis R","year":"2005","journal-title":"ACC Curr J Rev"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.50.601"},{"key":"e_1_2_8_29_1","first-page":"709","article-title":"factors of deep sternal wound infections in coronary artery bypass graft surgery","volume":"41","author":"Wang FD","year":"2000","journal-title":"J Cardiovasc Surg"},{"key":"e_1_2_8_30_1","first-page":"769","article-title":"Surgical site infection prevention bundle in cardiac surgery","volume":"112","author":"Andrade LS","year":"2019","journal-title":"Arq Bras Cardiol"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx328"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.13189"},{"key":"e_1_2_8_33_1","first-page":"1311","article-title":"Postoperative mediastinitis in cardiac surgery \u2013 pathophysiology, risk factors and prevention","volume":"31","author":"D'agostino D","year":"2015","journal-title":"Acta Medica Mediterr"},{"key":"e_1_2_8_34_1","first-page":"125","article-title":"Preventing deep wound infection after coronary artery bypass grafting: a review","volume":"40","author":"Bryan CS","year":"2013","journal-title":"Texas Heart Inst J"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1086\/665723"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(71)90199-1"},{"key":"e_1_2_8_37_1","first-page":"13","article-title":"Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS study group","volume":"67","author":"Moro ML","year":"1996","journal-title":"Ann Ital Chir"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1086\/506399"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.09.029"},{"key":"e_1_2_8_40_1","unstructured":"NICE.\u00a0Surgical site infections: prevention and treatment.Guidance and Guidelines.2019. NICE."},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2006.132191"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)36516-X"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)00282-9"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2011.07.012"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.06.045"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.10.020"},{"key":"e_1_2_8_47_1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1051\/ject\/200537381","article-title":"Use of platelet gel and its effects on infection in cardiac surgery","volume":"37","author":"Trowbridge CC","year":"2005","journal-title":"J Extra Corpor Technol"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.12.046"},{"key":"e_1_2_8_49_1","first-page":"102","article-title":"Primary closure of median sternotomy: techniques and principles","volume":"10","author":"Losanoff JE","year":"2002","journal-title":"Vascular"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000155"},{"key":"e_1_2_8_51_1","first-page":"212","article-title":"Deep sternal wound infection (DSWI) and mediastinitis after cardiac surgery: current approaches and future trends in prevention and management","volume":"36","author":"Chello C","year":"2020","journal-title":"Surg Technol Int"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(00)01301-1"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2011.07.004"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.10.008"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.08.030"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2019.03.005"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-5-117"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.1997.tb00104.x"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01560-X"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1159\/000072229"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.06.043"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-9-122"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0463.2007.00837.x"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2005.126250"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.14171"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.10.016"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200110000-00031"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001665-200605000-00006"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000316859.03788.44"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezt410"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.4155\/fsoa-2018-0004"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1039\/b707992n"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10856-013-5027-x"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10856-014-5249-6"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2016.01.021"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijac.12839"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10529-014-1697-9"},{"key":"e_1_2_8_78_1","doi-asserted-by":"publisher","DOI":"10.1088\/1748-605X\/aad73c"},{"key":"e_1_2_8_79_1","doi-asserted-by":"publisher","DOI":"10.1021\/acssuschemeng.8b00915"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.02.086"},{"key":"e_1_2_8_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.05.058"},{"key":"e_1_2_8_82_1","doi-asserted-by":"publisher","DOI":"10.1177\/1553350611412057"},{"key":"e_1_2_8_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.05.009"},{"key":"e_1_2_8_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.05.014"},{"key":"e_1_2_8_85_1","first-page":"8605313","article-title":"Adhesive\u2010enhanced sternal closure: feasibility and safety of late sternal reentry","volume":"2017","author":"Spooner AJ","year":"2017","journal-title":"Case Rep Surg"},{"key":"e_1_2_8_86_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-015-0230-0"},{"key":"e_1_2_8_87_1","doi-asserted-by":"publisher","DOI":"10.1039\/c4tb00155a"},{"key":"e_1_2_8_88_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2019.10.018"},{"key":"e_1_2_8_89_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-009-9704-3"},{"key":"e_1_2_8_90_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-011-0289-2"},{"key":"e_1_2_8_91_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-008-0064-1"},{"key":"e_1_2_8_92_1","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.237776"},{"key":"e_1_2_8_93_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.04.42"},{"key":"e_1_2_8_94_1","first-page":"57","article-title":"A meta\u2010analysis of platelet gel for prevention of sternal wound infections following cardiac surgery","volume":"15","author":"Kirmani BH","year":"2017","journal-title":"Blood Transfus"},{"key":"e_1_2_8_95_1","doi-asserted-by":"publisher","DOI":"10.1089\/ten.tea.2017.0505"},{"key":"e_1_2_8_96_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.suppl_3.III-307"},{"key":"e_1_2_8_97_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(00)01645-3"}],"container-title":["Medicinal Research Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/med.21758","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/med.21758","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/med.21758","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T16:44:20Z","timestamp":1693673060000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/med.21758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":96,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/med.21758"],"URL":"https:\/\/doi.org\/10.1002\/med.21758","archive":["Portico"],"relation":{},"ISSN":["0198-6325","1098-1128"],"issn-type":[{"value":"0198-6325","type":"print"},{"value":"1098-1128","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,11]]},"assertion":[{"value":"2020-06-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}