title: Reduction of sternal wound infections in diabetic patients undergoing off-pump coronary artery bypass surgery and using modified pedicle bilateral internal thoracic artery harvest technique.
abstract: OBJECTIVE
  We compared sternal wound infections between diabetic patients undergoing off-pump coronary artery bypass surgery using bilateral internal thoracic artery grafting or single internal thoracic artery grafting and nondiabetic patients receiving bilateral internal thoracic artery or single internal thoracic artery grafting using a modified pedicled harvest technique of internal thoracic artery.
  
  
  METHODS
  This retrospective study was conducted to analyze the data from 3072 patients who underwent primary coronary artery bypass surgery using an off-pump technique from August 2004 to October 2010. Of the 1211 diabetic patients, 181 received bilateral internal thoracic artery grafts (group 1) and 1030 received single internal thoracic artery grafts (group 2). Of the 1861 nondiabetic patients, 161 received bilateral internal thoracic artery grafts (group 3) and 1700 received single internal thoracic artery grafts (group 4). The incidence of postoperative sternal wound infections in diabetic patients who received bilateral internal thoracic artery grafting was compared with the incidence in other groups (group 2, 3, and 4). A modified technique of pedicled harvesting of the internal thoracic artery was done in patients receiving bilateral internal thoracic artery grafting, and a standard pedicled harvest was used in patients receiving single internal thoracic artery grafts.
  
  
  RESULTS
  No significant differences were present in the preoperative variables among the groups. The observed rate of superficial sternal wound infections in groups 1, 2, 3, and 4 was 1.1% (2 patients), 1.65% (17 patients), 1.86% (3 patients), and 1.65% (28 patients), respectively (P=.9941). Deep sternal infections were observed in 1 (0.55%), 5 (0.48%), 1 (0.62%), and 14 patients (0.82%) in groups 1 through 4, respectively (P=.8380). Multivariate analysis showed that bilateral internal thoracic artery harvesting (P=.889), diabetes mellitus (P=.96), and patient age were not predictors of sternal wound infection.
  
  
  CONCLUSIONS
  The results of the present study show that there is no increase in the incidence of sternal wound infections in diabetic patients undergoing coronary artery bypass surgery with bilateral internal thoracic artery grafting by using a modified pedicle bilateral internal thoracic artery harvesting technique with sparing of the communicating bifurcation of internal thoracic artery to the chest wall and preservation of pericardiacophrenic artery branch.
authors.affiliation: Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India. sajjalr@yahoo.com
authors.forename: Lokeswara Rao
authors.initials: LR
authors.lastname: Sajja
authors.forename: Gopichand
authors.initials: G
authors.lastname: Mannam
authors.forename: Satya Bhaskara Raju
authors.initials: SB
authors.lastname: Dandu
authors.forename: Sriramulu
authors.initials: S
authors.lastname: Sompalli
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000098:blood supply; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D035441:Thoracic Wall / Q000098:blood supply