Subscribe to RSS
DOI: 10.1055/s-0031-1297471
Sternal wound infections in cardiothoracic surgery: Single center experience in 84 consecutive patients
Objectives: Sternal wound infections (SWI) are a major cause of prolonged hospital stay and account for substantial mortality after cardiac operations. Surgical treatment is discussed controversially and commonly accepted guidelines are lacking. We evaluated our single center treatment algorithm and describe the different surgical techniques with their associated morbidity and mortality.
Methods: We retrospectively reviewed all superficial (SSWI) and deep sternal wound infections (DSWI) at our institution between 1/2010 and 8/2011. Surgical data were analyzed with respect to treatment modalities and in hospital mortality.
Results: Out of 1480 cardiac procedures 84 SWI (5.7%), 54 SSWI (3.6%) and 30 DSWI (2.0%) were documented. Pathogens involved were S. epidermidis (54%), S. aureus (8%), gram-negative rods (21%), others (9%) and more than one (8%). Mean time to the first intervention was 25±17 days. Modalities of treatment for SSWI consisted of local treatment and secondary closure in 5/54 patients (9%) or vacuum assisted closure (VAC) in 49/54 patients (91%). In DSWI rewiring and mediastinal lavage alone was performed in 13/30 patients(43%), partial/complete sternal resection followed by musculocutaneous flap (MCF) alone in 5/30 patients (17%) and 12/30 patients (40%) required MCF after failed rewiring. 19/30 patients(63%) had additional VAC treatment in the course of DSWI. In hospital mortality for patients with SSWI was 1.9% (1/54) and with DSWI 10% (3/30).
Conclusions: Sternal wound infection remains a potentially life- threatening complication in cardiac surgery. Following our institutional treatment algorithm to achieve secondary wound closure including VAC- therapy and the liberal use of vascularized flaps we obtained an acceptable in hospital mortality.