Pathological study of sternal osteomyelitis after median thoracotomy-a prospective cohort study
Olimpiu Bota1, Jessica Pablik2, Feras Taqatqeh3
1University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany. olimpiu.bota@uniklinikum-dresden.de.
Purpose:
Osteomyelitis of the sternum may arise either as a primary condition or secondary to median thoracotomy after cardiac surgery, with the latter being decidedly more frequent. Deep sternal wound infections appear as a complication of median thoracotomy in 0.2 to 4.4% of cases and may encompass the infection of the sternal bone. To date, there are no exhaustive histopathological studies of the sternal osteomyelitis.
Methods:
Our work group developed a surgical technique to remove the complete infected sternal bone in deep sternal wound infections. We therefore prospectively examined the en bloc resected sternal specimens. Seven standard histological sections were made from the two hemisternums.
Results:
Forty-seven sternums could be investigated. The median age of the patients in the cohort was 66 (45-81) years and there were 10 females and 37 males. Two methods were developed to examine the histological findings, with one model dividing the results in inflammatory and non-inflammatory, while the second method using a score from 0 to 5 to describe more precisely the intensity of the bone inflammation. The results showed the presence of inflammation in 76.6 to 93.6% of the specimens, depending on the section. The left manubrial sections were more prone to inflammation, especially when the left mammary artery was harvested. No further risk factors proved to have a statistical significance.
Conclusion:
Our study proved that the deep sternal wound infection may cause a ubiquitous inflammation of the sternal bone. The harvest of the left mammary artery may worsen the extent and intensity of infection.
Insights
Deep sternal wound infections frequently cause widespread sternum inflammation. Harvesting the left mammary artery may increase infection severity, highlighting a key risk factor in sternal osteomyelitis.
Area of Science:
- Medical pathology
- Surgical pathology
- Histopathology
Background:
- Osteomyelitis of the sternum can be primary or secondary to median thoracotomy.
- Deep sternal wound infections, a complication of median thoracotomy, occur in 0.2-4.4% of cases and may involve sternal bone infection.
- Exhaustive histopathological studies of sternal osteomyelitis are lacking.
Purpose of the Study:
- To conduct the first comprehensive histopathological examination of sternal osteomyelitis.
- To analyze the extent and intensity of inflammation in sternal bones affected by deep sternal wound infections.
- To identify potential risk factors associated with sternal osteomyelitis post-median thoracotomy.
Main Methods:
- Development of a surgical technique for en bloc resection of infected sternal bone.
- Prospective examination of 47 en bloc resected sternal specimens.
- Histological analysis using seven standard sections per hemisternum and two distinct scoring methods for inflammation.
Main Results:
- Inflammation was present in 76.6% to 93.6% of sternal specimens, indicating ubiquitous involvement.
- The left manubrium was more susceptible to inflammation, particularly after left internal mammary artery harvest.
- No other investigated risk factors showed statistical significance.
Conclusions:
- Deep sternal wound infections lead to widespread inflammation of the sternal bone.
- Harvesting the left internal mammary artery appears to exacerbate the extent and intensity of sternal osteomyelitis.
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