Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site
Alexandra Blake1, Megan Condrey1, Leslie Hansen1
1Dominion Plastic Surgery, Falls Church, Virginia, USA.
Insights
Sternal rigid plate fixation (SRPF) offers successful sternal wound healing in cardiac surgery patients, even with active infections. This method demonstrates comparable outcomes to traditional approaches, reducing complications and improving stability.
Area of Science:
- Cardiovascular Surgery
- Plastic and Reconstructive Surgery
- Infectious Disease Management
Background:
- Sternal complications post-cardiac surgery lead to significant morbidity and mortality.
- Current reconstructive methods often involve functional loss.
- Sternal rigid plate fixation (SRPF) shows promise but its use in infected sternal wounds is debated.
Purpose of the Study:
- To evaluate the outcomes of sternal rigid plate fixation (SRPF) in patients with and without sternal infections.
- To compare the efficacy of SRPF in infected versus clean sternal wounds.
- To assess the impact of surgeon experience on infection rates after SRPF.
Main Methods:
- Retrospective study of 97 patients undergoing SRPF by a single surgeon (April 2013 - August 2021).
- Patients were categorized into infected (INFECTED) and clean (CLEAN) groups.
- Demographic and peri-operative factors were analyzed for association with post-SRPF sternal infection.
Main Results:
- 16% of infected cases and 14% of clean cases experienced subsequent infections.
- A significant decrease in overall infection rates was observed with increased surgeon experience (p < 0.0001).
- All patients, regardless of initial infection status, achieved stable sternal healing.
Conclusions:
- SRPF is a viable and successful treatment option for sternal wounds, including those with active infections.
- There is no statistically significant difference in infection development based on pre-SRPF wound class.
- SRPF can be safely employed in infected settings, leading to stable sternal healing.
Abstract:
Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections. This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated. Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p < 0.0001) as experience and frequency of plate fixation increased (p < 0.0001). Regardless of infection status, all but one patient had a healed and stable sternum at the end of data collection. There is no statistically significant difference between wound class prior to SRPF and development of infection after SRPF. Even in infected settings, patients can be treated successfully with SRPF. Further study is needed.
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