The management of complicated sternal dehiscence following open heart surgery.
BACKGROUND
Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves.


METHODS
The technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks.


RESULTS
Twenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke.


CONCLUSIONS
We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.
Imren
Yildirim
Y
Department of Cardiovascular Surgery, Gazi Hospital, Ankara, Turkey. yimren@gazi.edu.tr
Selek
Hakan
H
Zor
Hakan
H
Bayram
Huseyin
H
Ereren
Emrah
E
Tasoglu
Irfan
I
Sariguney
Yakup
Y
D001860:Bone Plates; D001864:Bone Wires; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing