Management of intractable sternal wound infections with topical negative pressure dressing.
BACKGROUND
Sternal osteomyelitis after cardiac surgery is a life-threatening complication. The potential spread of infection into the mediastinum, involving the prosthetic valve, grafts, and suture lines, makes this an extremely serious complication confronting both cardiac and plastic surgeons.


OBJECTIVE
Topical negative pressure (TNP) dressing has been proven to be effective for wound healing. We want to take advantages of this equipment to improve the results of intractable sternal wound infection. The results are discussed.


METHODS
From December 1996 to July 2002, 25 patients with sternal wound infections were treated at Kaohsiung Medical University Hospital. Nine patients suffering intractable sternal osteomyelitis were managed with debridement and TNP dressings. These patients received 1-3 debridements (an average of 2.2 debridements), and the average TNP dressing treatment period was 20.2 days (ranging from 3 to 43 days). After management, the infections were controlled and healthy vascularized wounds were achieved. Then, flap reconstruction could be performed for complete wound closure. Seven of the nine patients survived, and there was no recurrence of sternal osteomyelitis during follow-up period (ranging from 5 to 70 months).


CONCLUSIONS
The advantages of applying TNP dressings in cases of intractable sternal wound infections include (1) protecting the underlying mediasternal structure from infection, (2) permitting delayed sternal closure to avoid cardiac compression induced compromised cardiopulmonary function, (3) possibility of repeated wound inspection and bedside debridement, (4) cost-effectiveness of wound care, and (5) providing an option to promote sternal wound secondary healing for patients in poor physical condition.
Lee
Su-Shin
SS
Division of Plastic and Reconstructive Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. sushin@kmu.edu.tw
Lin
Sin-Daw
SD
Chen
Huai-Min
HM
Lin
Tsai-Ming
TM
Yang
Chin-Chiang
CC
Lai
Chung-Sheng
CS
Chen
Ying-Fu
YF
Chiu
Chaw-Chi
CC
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D010019:Osteomyelitis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D011312:Pressure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013249:Sternum / Q000473:pathology*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013624:Taiwan; D014057:Tomography, X-Ray Computed; D014945:Wound Healing / Q000502:physiology