Early detection of sternal dehiscence by conventional chest X-ray.
BACKGROUND
Diagnosis of sternal dehiscence after sternotomy for cardiac surgery is still made clinically. The aim of this study was to identify radiographic signs of sternal dehiscence by routine chest X-ray (CXR) in patients with and without clinically diagnosed sternal dehiscence.


METHODS
75 patients (group I: 65 +/- 9.3 years, f/m = 12/63) with clinically diagnosed sternal dehiscence, necessitating surgical revision and 75 patients with uneventful sternal healing (matched to group I by age, sex, preoperative risk factors and surgical procedures; group II: 66 +/- 9.0 years, f/m = 12/63) were included in this study. Serial CXRs immediately after surgery until re-intervention or discharge were analyzed by a radiologist, blind to the date of redo surgery.


RESULTS
In 39 patients of group I (52%) vs. 8 (10.7%) in group II, abnormalities in the sternal wire and/or a midsternal stripe could be found (p < 0.0001): rotated wires (p = 0.003), shifted wires (p = 0.043), and ruptured wires (p = 0.312). Seven patients presented with combined wire abnormalities in group I vs. 0 in group II. Midsternal stripe sign could be detected in 26 patients of group I vs. 3 in group II (p < 0.0001). Sternal dehiscence was suspected based on the above mentioned abnormalities as early as three days postoperatively (Q1 = 2; Q3 = 8 days) in 39 patients, whereas clinical diagnosis of sternal dehiscence was delayed up to ten days postoperatively (Q1 = 7; Q3 = 13 days).


CONCLUSIONS
Radiographic signs of sternal dehiscence could be detected before the clinical diagnosis was apparent and predicted sternal dehiscence in more than half of the patients.
Peivandi
A A
AA
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. peivandi@uni-mainz.de
Vogel
N
N
Opfermann
U T
UT
Singelmann
J
J
Kuroczynski
W
W
Kreitner
K F
KF
Dahm
M
M
Vahl
C F
CF
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013249:Sternum; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging*; D013908:Thoracotomy / Q000009:adverse effects*; D014945:Wound Healing