title: Disruption and infection of median sternotomy: a comprehensive review.
abstract: Disruption and infection of median sternotomy wounds are grave complications often associated with prolonged hospitalization, high cost, and significant mortality. Effective prevention techniques are still debated. Successful management requires early recognition based on a high index of suspicion, detailed physical examination, appreciation of the clinical signs and symptoms, timely imaging studies, and prompt surgical therapy. Improvements in perioperative management and critical care of patients with multisystem organ failure can reduce morbidity and mortality rates. Sternal salvage and direct sternal reclosure are possible when the infection is diagnosed early. Techniques utilizing lateral sternal support should be first-line options in the condition. Muscle flap techniques should be the next consideration when direct closure has failed or cannot be attempted.
authors.affiliation: Department of Surgery, M580 Health Sciences Center, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Julian E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Richman
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D008480:Mediastinitis / Q000601:surgery; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D013536:Suture Techniques
chemical_list: D000900:Anti-Bacterial Agents