Algorithm for primary closure in sternal wound infection: a single institution 10-year experience
Alain Jean Poncelet1, Benoit Lengele, Bénédicte Delaere
1Department of Cardio-Vascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium. poncelet@chir.ucl.ac.be
Summary
Deep sternal wound infection (SWI) is a serious cardiac surgery complication. A simple treatment algorithm with primary closure and vascularized flaps shows satisfactory short-term outcomes for patients with deep SWI.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Wound Management
Background:
- Sternal wound infection (SWI) is a significant complication following cardiac surgery.
- Risk factors for SWI are well-established, but effective treatment algorithms are crucial.
Purpose of the Study:
- To evaluate a straightforward treatment algorithm for sternal wound infection (SWI) that permits primary closure.
- To detail surgical techniques and analyze associated morbidity and mortality.
Main Methods:
- Retrospective analysis of 5905 cardiac surgery patients from 1996-2004.
- Prospective collection of epidemiological and surgical data.
- Univariate and multivariate analyses to identify mortality risk factors.
Main Results:
- 146 SWIs occurred (2.4%), with higher incidence after CABG and combined procedures.
- Common pathogens included S. epidermidis and S. aureus.
- Deep SWI (DSWI) had a 90-day mortality of 14.5%, significantly higher than superficial SWI or uninfected patients.
Conclusions:
- Deep sternal wound infection (DSWI) remains a critical complication in cardiac surgery.
- A simple approach combining primary closure and vascularized flaps yields favorable short-term outcomes for DSWI patients.
