Primary or delayed closure for the treatment of poststernotomy wound infections?
OBJECTIVE
The methods of primary versus delayed wound closure for the treatment of sternal wound infections after cardiac surgery were retrospectively compared.


METHODS
From January 2001 to March 2003, 132 patients (median age 66 years, male to female ratio 88:44) with sternal wound infection after cardiac surgery were treated at our department. After thorough debridement, 35 patients received preconditioning of the wound before implementation of definitive therapy; the remainder (97 patients) were treated with immediate closure.


RESULTS
From the 35 patients with preconditioning, 19 patients proceeded to delayed primary closure, whereas the remaining 14 patients were referred to plastic reconstruction with a pectoralis muscle flap. Primary success rate in this group was 100%. In the immediate primary closure group, 33 patients experienced 1 or more therapy failures, resulting in a recurrence rate of 39%. Fifteen patients received a pectoralis muscle flap as definite treatment modality.


CONCLUSIONS
Immediate primary closure is associated with a high rate of local infection recurrence. Surgical debridement and conditioning of the wound until resolution of infections with delayed primary closure or plastic reconstruction is suggested as the more appropriate treatment modality, with promising results.
Fleck
Tatjana M
TM
Department of Cardiothoracic Surgery, University of Vienna, AKH Vienna, Leitstelle 20A, Währinger Gürtel 18-20, 1090 Vienna, Austria. t9204604@hotmail.com
Koller
Rupert
R
Giovanoli
Pietro
P
Moidl
Reinhard
R
Czerny
Martin
M
Fleck
Michael
M
Wolner
Ernst
E
Grabenwoger
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000382:microbiology* / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome