Delayed primary closure of deep sternal wound infections.
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.
Zacharias
A
A
Department of Cardiovascular Surgery, St. Vincent Medical Center, Toledo, Ohio 43608-2691, USA.
Habib
R H
RH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures; D003646:Debridement; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum; D008722:Methods; D008875:Middle Aged; D009336:Necrosis; D009765:Obesity / Q000150:complications; D010019:Osteomyelitis / Q000209:etiology; D012086:Reoperation; D013249:Sternum; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents