Sternal wound complications. Management and results

Area of Science:

• Cardiovascular Surgery
• Infectious Disease Management

Background:

• Median sternotomy is a common approach for cardiac operations.
• Sternal wound complications (SWCs) occur in 1.8% of patients undergoing median sternotomy.
• Severe SWCs, including septicemia and mediastinal abscess, are associated with high mortality.

Purpose of the Study:

• To evaluate the efficacy of two management methods for sternal wound complications after median sternotomy.
• To compare outcomes between Method A (conservative management) and Method B (surgical débridement and irrigation).

Main Methods:

• Method A: Incision and drainage with frequent dressing changes/irrigation for superficial SWCs.
• Method B: Surgical débridement, reclosure, and mediastinal irrigation with 0.5% povidone-iodine for severe SWCs.
• Retrospective comparison of patient outcomes based on the management method received.

Main Results:

• Method B demonstrated superior outcomes in patients with severe SWCs compared to those not treated with Method B.
• In severe SWC cases, Method B resulted in 0% mortality and only 1 recurrent infection among 8 patients.
• In contrast, 11 of 28 patients with severe SWCs not treated with Method B died, and 13 experienced recurrent infections.

Conclusions:

• Method A is suitable for superficial SWCs with no systemic reaction.
• Method B is recommended for patients with draining, unstable sternums, retrosternal space infections, or systemic reactions unresponsive to Method A.
• Method B significantly improves survival and reduces recurrence in severe sternal wound complications following cardiac surgery.