Article
Deep sternal wound infection after cardiac surgery
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Authors
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Philipp Kolat
- Universitätsklinik Regensburg, Herz-, Thorax- & Herznahe Gefäßchirurgie, Regensburg
| Published: | April 26, 2013 |
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Outline
Text
Introduction: Deep sternal wound infection (DSWI) is one the most feared complications in cardiac surgery due to excessive morbidity and mortality.
Material and methods: We retrospectively analyzed 27 patients with DSWI, defined as osteomyelitis and mediastinitis. The surgical treatment strategy included partial sternectomy, vacuum-assisted wound therapy and – part of them - reconstructive surgery.
Results: Among this cohort, there were 20 (74%) men, median age was 69 ( /-9.7) years. Co-morbidities and risk factors for wound disorders included body mass index (BMI, 31.1 kg/m² ( /-8.5)), use of single (ITA, n=20) or both internal thoracic arteries (BITA, n=1), diabetes (n=17), renal insufficiency with or without necessity of dialysis (n=12), active nicotine abuse (n=4), peripheral arterial disease (n=13), chronic obstructive pulmonary disease (n=14) as well as preoperative steroid therapy (n=6). Most common operation was coronary artery bypass grafting (CABG, 66.7%) followed by a combination procedure (CABG valve, 22.2%). All patients underwent partial sternectomy during clinical course. Vacuum-assisted wound therapy was necessary in 20 patients (74%). Conventional wound closure was not possible in 16 patients (59%). Reconstructive surgery included omental flap, latissimus as well as pectoralis muscle transfer. 5.4 ( /-3.9) operations were performed per patient, median length of stay in hospital after first operative revision due to DSWI was 70.4 ( /-33.1) days. Median interval from first operation till first revision was 24.7 ( /-39.8) days. In-hospital mortality was 7.4%, overall mortality was 29.6% (n=8). Four patients died of septic multi-organ failure. All other patients, except one, completely recovered and are in good health since today.
Conclusion: Treatment of DSWI in post-sternotomy patients is a severe complication still associated with high mortality. Numerous risk factors, comorbidities as well as the patients´ reduced general condition are challenging to the surgeon. Sternectomy and VAC-therapy, possibly followed by reconstructive surgery is necessary to treat DSWI successfully.
