Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation.
OBJECTIVE
To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps.


METHODS
Between 2002 and 2007, 10665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients.


RESULTS
Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p=0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p<0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal.


CONCLUSIONS
To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.
Department of Cardiac and Plastic Surgery, Laval University, QC, Canada.
Geneviève
G
Gaudreau
Victor
V
Costache
Chanel
C
Houde
Daniel
D
Cloutier
Livia
L
Montalin
Pierre
P
Voisine
Richard
R
Baillot
D000368:Aged; D001860:Bone Plates; D006348:Cardiac Surgical Procedures; D003646:Debridement; D020878:Device Removal; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000628:therapy; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods; D012008:Recurrence; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy; D014025:Titanium
D014025:Titanium