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Eur J Cardiothorac Surg 2001;19:811-816
© 2001 Elsevier Science NL

Deep sternal wound infection: the role of early debridement surgery

^a Department of Cardio-Thoracic and Respiratory Sciences, V. Monaldi Hospital, Second University of Naples, Naples, Italy
^b Institute of Infectivology, V. Monaldi Hospital, Second University of Naples, Naples, Italy

Received 9 October 2000; received in revised form 13 March 2001; accepted 14 March 2001.

Corresponding author. FECTS, via Aquila 144, 80143, Naples, Italy. Tel.: +39-081-5539035; fax: +39-081-5536350
e-mail: arenzul{at}tin.it

Objective: This retrospective chart review study aimed to evaluate whether a more aggressive staged approach can reduce morbility and mortality following post-cardiotomy deep sternal wound infection. Methods: Between 1979 and 2000, 14 620 patients underwent open heart surgery: mediastinitis developed in 124 patients (0.85%). Patients were divided in two groups: in 62 patients (Group A) (1979–1994) an initial attempt of conservative antibiotic therapy was the rule followed by surgical approach in case of failure; in 62 patients (Group B) (1995–2000) the treatment was staged in three phases: (1) wound debridment, removal of wires and sutures, closed irrigation for 10 days; (2) in case of failure open dressing with sugar and hyperbaric therapy (11 patients, 17%); (3) delayed healing and negative wound cultures mandated plastic reconstruction (three patients, 4%). Categorical values were compared using the Chi-square test, continuous data were compared by unpaired t-test. Results: Incidence of mediastinitis was higher in Group B (62 out of 5535; 1.3%) than in Group A (62 out of 9085; 0.7%) (P=0.007). Mean interval between diagnosis and treatment was shorter in Group B (18±6 days) than in group A (38±7 days) (P=0.001). Hospital mortality was higher in Group A (19/62; 31%) than in Group B (1 out of 62; 1.6%) (P<0.001). Hospital stay was shorter in Group B (30.5±3 days) than in group A (44±9 days) (P=0.001). In Group B complete healing was observed in all the 61 survivors: 47 cases (76%) after Stage 1; 11 (18%) after Stage 2; three (4.8%) after Stage 3. Conclusions: Although partially biased by the fact that the two compared groups draw back to different decades, this study showed that an aggressive therapeutic protocol can significantly reduce morbility and mortality of deep sternal wound infection.

Key Words: Deep sternal wound infection • Closed chest irrigation • Sugar dressing • Pectoralis muscle flap reconstruction

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