[Our experience with diagnosis, evaluation and treatment of poststernotomy sternal wound infections]

During 1984-1992 162 patients with post-sternotomy sternal wound infections were treated. Between 0.4-5% of these undergoing sternotomy suffer from this complication which carries a mortality of about 50% when treated by conventional, nonsurgical methods. 80% of our patients had undergone aortocoronary bypass surgery and 11% valve replacement. Major risk factors identified for postoperative infection were prolonged mechanical ventilation, prolonged extracorporeal bypass, smoking, diabetes, obesity and chronic lung disease. Of 152 patients who underwent surgery, 35 had recurrent infections, especially during the first years of the study. 10 were managed by conservative methods. Reconstruction of the chest wall was performed in 125, using pectoralis major flaps (74 cases), rectus abdominis muscle flaps (53), myocutaneous flaps (5) and omental flap (1). Our series demonstrates the importance of a comprehensive, multi-disciplinary approach in evaluating and stabilizing these often critically ill patients. Computed tomography together with sinography have proven to be of major importance in diagnosing the location and extent of sternal wound infections. Strict adherence to antibiotic protocols, radical debridement of infected bone and soft tissues and subsequent reconstruction with muscle flaps has enabled us to reduce recurrent infection and improve morbidity and mortality rates.