Delayed primary closure of deep sternal wound infections

Tex Heart Inst J. 1996;23(3):211-6.

Abstract

Deep infections of the sternum and mediastinum, with prevalence of osteomyelitis and tissue necrosis, were documented in 38 of 8,056 patients (0.47%) who underwent open-heart surgery (1975 through 1994) in our service. The incidences of insulin-dependent diabetes, obesity, and emergency surgery in these patients were relatively high at 39%, 47%, and 18%, respectively. Treatment with antibiotics, débridement, open packing, and delayed closure was administered to 33 patients (87%), with 100% healing. There were no deaths in this group. Flap reconstruction was indicated in 5 gravely ill patients (13%) in whom excessively large wound defects did not allow reapproximation. There were 2 deaths in this group, and 4 reoperations were necessary in the surviving patients because of sequelae arising from flap reconstruction. The overall mortality was 5.3% and the median period of hospitalization was 29 days. The length of stay decreased substantially over the period of this study (median = 21 days, year > or = 1987). Accordingly, we believe that treatment of deep sternal infections with delayed primary closure is safe and effective. Also, given the increased potential for complications and long-term sequelae, we believe that flap reconstruction should be used selectively and should be limited to patients with large defects, uncontrolled mediastinal bleeding, or both.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Cardiac Surgical Procedures*
  • Debridement
  • Diabetes Mellitus, Type 1 / complications
  • Emergencies
  • Female
  • Humans
  • Male
  • Mediastinum*
  • Methods
  • Middle Aged
  • Necrosis
  • Obesity / complications
  • Osteomyelitis / etiology
  • Reoperation
  • Sternum*
  • Surgical Flaps
  • Surgical Wound Infection / mortality
  • Surgical Wound Infection / pathology
  • Surgical Wound Infection / surgery*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents