title: Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections.
abstract: OBJECTIVE
  Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period.
  
  
  METHODS
  Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department. In 94 patients (3%), a deep sternal wound infection occurred, including sternal instability with consecutive surgical treatment. The patients either received wound debridement with sternum refixation and suction-irrigation drainage (SID; n = 72) or sternum refixation only (RF; n = 22) if there was sternal instability with limited signs of infection. SID was routinely installed for 7 days: the irrigation solution contained neomycin. In all cases, swabs were taken and analysed. The different methods were evaluated in respect of their clinical outcomes.
  
  
  RESULTS
  The success rate-defined as single, uncomplicated procedure-of the SID treatment was 74%, compared with 59% of the isolated sternum refixation. Complications included continuous infection, recurrence of sternal instability and wound necrosis. Eighty-eight percent of the swabs in the SID group were positive, compared with 32% in the sternal refixation only group. The dominating pathogenic germs were coagulase-negative staphylococci and staphylococcus aureus. Mortality was 10% for the SID group and 5% for the RF group.
  
  
  CONCLUSIONS
  Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality.
authors.affiliation: Department for Cardiothoracic Surgery, Heart and Vessel Centre Bad Bevensen, Bad Bevensen, Germany. deschkaheinz@hotmail.com
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.forename: Stefan
authors.initials: S
authors.lastname: Erler
authors.forename: Lemir
authors.initials: L
authors.lastname: El-Ayoubi
authors.forename: Cordula
authors.initials: C
authors.lastname: Vogel
authors.forename: Luise
authors.initials: L
authors.lastname: Vöhringer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D009355:Neomycin / Q000008:administration & dosage*; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013396:Suction / Q000009:adverse effects / Q000401:mortality; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D009355:Neomycin
keywords: Deep sternal wound infection; Suction-irrigation drainage; Wound closure