title: Algorithm for primary closure in sternal wound infection: a single institution 10-year experience.
abstract: OBJECTIVE
  To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality.
  
  
  METHODS
  A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality.
  
  
  RESULTS
  Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3+/-12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p=0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p<0.0001).
  
  
  CONCLUSIONS
  Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.
authors: Department of Cardio-Vascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium. poncelet@chir.ucl.ac.be
authors: Alain Jean
authors: AJ
authors: Poncelet
authors: Benoit
authors: B
authors: Lengele
authors: Bénédicte
authors: B
authors: Delaere
authors: Francis
authors: F
authors: Zech
authors: David
authors: D
authors: Glineur
authors: Jean-Christophe
authors: JC
authors: Funken
authors: Gebrine
authors: G
authors: El Khoury
authors: Philippe
authors: P
authors: Noirhomme
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003646:Debridement; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery*