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Sternal wound infection: our experience with 200 cases
1Department of Plastic Surgery (and unit for Chestwall Reconstruction), Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
The Journal of Cardiovascular Surgery
|December 1, 1994
Summary
Sternal wound infections after cardiac surgery are increasingly severe. Treatment evolved from conservative methods to surgical debridement and reconstruction using pectoralis muscles, improving outcomes for complex cases.
Area of Science:
- Plastic Surgery
- Cardiothoracic Surgery
- Infectious Diseases
Background:
- Over 200 sternal wound infection (SWI) cases treated 1984-1993, many referred from other hospitals.
- Increasing severity of SWI linked to operating on older, sicker patients, primarily post-coronary bypass surgery.
- SWI encompasses complications following cardiac transplants, congenital anomaly repairs, and valve replacements.
Purpose of the Study:
- To review treatment strategies and outcomes for sternal wound infections.
- To identify risk factors and evolving infectious agents associated with SWI.
- To evaluate the role of pre-operative imaging in managing SWI.
Main Methods:
- Retrospective analysis of over 200 SWI patients treated between 1984 and 1993.
- Review of surgical techniques, including sternal debridement and reconstruction methods (rectus abdominis vs. pectoralis muscle flaps).
- Analysis of pre-operative imaging findings and microbiological data.
Main Results:
- Earlier patients often presented with chronic fistulae; recent cases are typically acute.
- Surgical debridement (sternal/rib removal) is common, with pectoralis muscle flaps increasingly used for reconstruction.
- Imaging is crucial for defining infection extent and locating foreign bodies; Pseudomonas aeruginosa was a prevalent early infectant.
Conclusions:
- SWI management has shifted towards earlier surgical intervention and advanced reconstruction techniques.
- Pre-operative imaging and understanding evolving pathogens are vital for successful SWI treatment.
- Pectoralis muscle flaps represent an effective reconstruction option for SWI.