HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alain Jean Poncelet Gebrine El Khoury Philippe Noirhomme Permission Requests Google Scholar Articles by Poncelet, A. J. Articles by Noirhomme, P. PubMed Articles by Poncelet, A. J. Articles by Noirhomme, P. Related Collections Mediastinum Cardiac - other

Algorithm for primary closure in sternal wound infection: a single institution 10-year experience

^a Department of Cardio-Vascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium
^b Department of Infectious Diseases, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium
^c Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium

Received 4 June 2007; received in revised form 21 November 2007; accepted 22 November 2007.

^_* Corresponding author. Address: Cardio-Vascular and Thoracic Surgery Unit, Cliniques universitaires St-Luc, Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium. Tel.: +32 2 7646107; fax: +32 2 7648960. (Email: poncelet{at}chir.ucl.ac.be).

Objectives: To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality. Methods: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality. Results: Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3 ± 12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p = 0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p < 0.0001). Conclusions: Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.

Key Words: Surgery cardiothoracic • Bypass coronary surgery • Mediastinitis • Decision making