Sternal wound infections following cardiac surgery: risk factor analysis and interdisciplinary treatment
Thomas Strecker1, Johannes Rösch, Raymund E Horch
1Center of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. thomas.strecker@herz.imed.uni-erlangen.de
Insights
Surgical site infections after cardiac surgery can be serious. Operating in the morning and using vacuum-assisted closure therapy can improve outcomes for sternal wound infections.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Management
- Wound Healing and Reconstruction
Background:
- Sternal wound infections (SWIs) are a significant complication following median sternotomy in cardiac surgery.
- Optimal operative treatment for complicated SWIs remains a subject of debate.
- Identifying risk factors and effective management strategies is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the incidence and risk factors of sternal wound infections after cardiac surgery.
- To assess the effectiveness of different treatment modalities for complicated SWIs.
- To highlight an interdisciplinary approach for managing these infections.
Main Methods:
- Retrospective review of 3016 cardiac surgery patients (January 2003 - June 2006).
- Analysis of patient demographics, surgical procedures, and sternal wound infection development.
- Evaluation of treatment strategies including debridement, re-wiring, vacuum-assisted closure (VAC), and plastic surgical coverage.
Main Results:
- Sixty-three patients (2.1%) developed SWIs.
- Significant risk factors included diabetes, rethoracotomy, operation duration, and afternoon surgery.
- Vacuum-assisted closure therapy facilitated definitive plastic surgical coverage in 19 patients, with successful reconstruction and no recurrence of osteomyelitis.
Conclusions:
- Morning surgery may reduce the risk of SWIs in high-risk patients.
- Vacuum-assisted closure serves as an effective bridge between debridement and plastic surgical reconstruction.
- An interdisciplinary approach involving radical debridement, VAC therapy, and early plastic surgery consultation ensures efficient management of SWIs.
Objective:
Sternal wound infections are a serious complication after cardiac surgery. Although a variety of treatment algorithms has been published, the ideal operative treatment of complicated median sternotomy wounds is the subject of ongoing controversy.
Methods:
In a retrospective review, 3016 consecutive open-heart surgery patients between January 2003 and June 2006 were evaluated: 65.6% underwent coronary artery bypass surgery (CABG), 16.3% cardiac valve replacement, 13.5% combined CABG and valve replacement, 2.8% aortic reconstruction or replacement, 0.6% artificial heart implantation, and 1.2% cardiac transplantation.
Results:
Sixty-three patients (2.1%) developed sternal wound infections. Fifty-six wounds were treated with débridement, irrigation, and re-wiring. Thirty-four patients were treated using vacuum-assisted closure therapy. Nineteen of these patients eventually required plastic surgical coverage with either rectus abdominis or pectoralis major flaps. Diabetes mellitus, rethoracotomy, duration of operation and, interestingly, the time of operation (morning versus afternoon) presented significant risk factors for development of sternal wound infections (P <.05). Three patients developed partial flap necrosis and required a second flap. Eventually, all defects were successfully reconstructed and there was no recurrent ostemyelitis noticed over the entire observation period (follow-up, 23 +/- 13 months).
Discussion:
Patients at risk for development of sternal wound infections may be preferably operated in the morning at first position. Vaccuum-assisted closure therapy acts as a link between radical débridement and definitive plastic coverage. The type of flap is individually chosen based on location of the defect and availability of certain vascular axis. The presented interdisciplinary approach with radical surgical débridement, application of subatmospheric pressure dressings, and early involvement of the plastic surgical team allows efficient treatment of infected median sternotomy wounds.
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