title: Sternoclavicular joint infection: a comparison of two surgical approaches.
abstract: BACKGROUND
  This study compares conventional open debridement with the recently proposed flap closure technique for sternoclavicular joint infection.
  
  
  METHODS
  This is a retrospective review of patients undergoing surgery for sternoclavicular joint infection during the last 7 years.
  
  
  RESULTS
  Twenty patients underwent 35 operations for sternoclavicular joint infection from 2002 to 2009. The debridement and open wound procedure (10 of 20 patients, 50%) involved debridement of the clavicle, manubrium, and first rib and open wound care. The joint resection and flap closure procedure (10 of 20 patients, 50%) involved partial resection of the clavicle, manubrium, and first rib, with immediate (9 of 10) or early (1 of 10) wound closure with pectoralis major advancement flap. The two groups were comparable in comorbidities, duration of symptoms, radiologic findings, and microbiologic results. Despite an approach of planned reoperation for wound care, the open group had fewer mean procedures performed per patient (1.6±0.7 versus 1.9±1.6), owing to fewer unplanned procedures (0 versus 0.8 procedures/patient) than the flap group. The incidence of wound complications (hematoma, seroma) was lower in open patients (0 of 10 versus 5 of 10). The median length of hospitalization was shorter in the open group (5.5 versus 10.5 days), but all open patients (10 of 10; 100%) required prolonged wound care compared with 2 of 10 (20%) in the flap group. The only hospital mortality occurred in the flap group. Eventual wound healing was satisfactory in all survivors.
  
  
  CONCLUSIONS
  For sternoclavicular joint infection, a single-stage resection and muscle advancement flap leads to a higher incidence of complications. Debridement with open wound care provides satisfactory outcomes with minimal perioperative complications but requires prolonged wound care.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University, Barnes Jewish Hospital, St. Louis, Missouri 63110, USA. puriv@wudosis.wustl.edu
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Traves D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Battafarano
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Krupnick
mesh_terms: D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D015331:Cohort Studies; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013247:Sternoclavicular Joint; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013524:Surgical Flaps; D016896:Treatment Outcome