title: Association of sternal wound infection with parasternal muscle sutures.
abstract: BACKGROUND
  Sternal wound infection complicating open-heart surgery is a potentially devastating complication that has been associated with a number of risk factors. We recently consulted on three consecutive patients with this complication who had heavy nonabsorbable parasternal sutures placed in muscle tissue adjacent to the sternum. The aim of this report is to document our findings and caution that this technique to control bleeding from the parasternal intercostal muscles my increase risk of infection.
  
  
  METHODS
  The pathology, surgical findings, and microbiology of these three cases are analyzed for similarity and possible cause of infection.
  
  
  RESULTS
  By surgical observation and culture reports, each infection appeared to have originated at the site of nonabsorbable suture in devascularized parasternal muscle tissue. Sinus tracts could be probed to a similar site in each patient.
  
  
  CONCLUSIONS
  Placement of sutures in the parasternal muscles where the sternal wires wrap around the bone leads to compression and necrosis of muscle tissue. We caution that this technique to control bleeding may cause a nidus of infection and increase the risk of deep sternal wound infection.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA. stahlk@ccf.org
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Stahl
authors.forename: Harry K
authors.initials: HK
authors.lastname: Moon
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Gorensek
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.forename: Delos M
authors.initials: DM
authors.lastname: Cosgrove
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013537:Sutures / Q000009:adverse effects*