Prevention, Classification and Management Review of Deep Sternal Wound Infection
Khaled Alebrahim1, Ebrahim Al-Ebrahim2
1Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia. dr.k.ebrahim@gmail.com.
Insights
Sternal wound complications after cardiac surgery pose serious risks. Improved classification and evidence-based management strategies are needed to reduce mortality and morbidity.
Area of Science:
- Cardiovascular Surgery
- Wound Management
- Infectious Disease
Background:
- Sternal wound complications are a major challenge in cardiac surgery, leading to high mortality, morbidity, and increased healthcare costs.
- Identifying risk factors and implementing preventive measures for sternal wound infection is crucial.
- Existing classifications for sternotomy complications lack a universally accepted evidence-based approach.
Purpose of the Study:
- To review current literature on sternal wound complications post cardiac surgery.
- To highlight the need for improved classification systems for better categorization and management.
- To identify gaps in evidence-based surgical consensus regarding management strategies.
Main Methods:
- Literature review of sternal wound classifications and management strategies.
- Analysis of historical and recent approaches to classifying sternotomy complications.
- Examination of evidence regarding surgical consensus on wound closure and coverage.
Main Results:
- Initial classifications focused on the timing of infection and risk factors.
- Recent classifications emphasize anatomical descriptions (depth, location) for practicality.
- A significant lack of evidence-based consensus exists for optimal management, including closure techniques and reconstructive options.
Conclusions:
- Sternal wound complications necessitate focused attention due to their severe impact.
- Anatomical classification offers a more practical approach to understanding sternal wound issues.
- Further research is required to establish evidence-based guidelines for sternal wound management post-cardiac surgery.
Abstract:
Sternal wound complications are significant problems in cardiac surgery and cause challenges to surgeons as they are associated with high mortality, morbidity, and a tremendous load on the hospital budget. Risk factors and preventive measures against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post cardiac surgery is important for specific categorization and management. Reviewing the literature, a variety of classifications was introduced to help understand the pathophysiology of these wounds and how best to manage them. Initial classifications were based on the postoperative period of the infectious process and risk factors. Recently, the anatomical description of sternal wound, including the depth and location, was shown to be more practical. There is a lack of evidence-based surgical consensus for the appropriate management strategy, including type of closure, choice of sternal coverage post sternectomy, whether primary, delayed and when to use reconstructive flaps.
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