Algorithm for primary closure in sternal wound infection: a single institution 10-year experience.
(2008) European Journal of Cardio-Thoracic Surgery — Vol. 33, n° 2, p. 232-238 (2008)
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Zech, Francis 
- Abstract
- OBJECTIVES: To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality. METHODS: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality. RESULTS: Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3+/-12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p=0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p<0.0001). CONCLUSIONS: Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.
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Citations
Poncelet, A., Lengelé, B., Delaere, B., Zech, F., Glineur, D., Funken, J.-C., El Khoury, G., & Noirhomme, P. (2008). Algorithm for primary closure in sternal wound infection: a single institution 10-year experience. European Journal of Cardio-Thoracic Surgery, 33(2), 232-238. https://doi.org/10.1016/j.ejcts.2007.11.016 (Original work published 2008)