Changes in the management of deep sternal wound infections: a 12-year review.
BACKGROUND
Deep sternal wound infection (DSWI) is a rare but life-threatening complication following cardiac surgery associated with increased morbidity and mortality. Management of these patients has evolved over the years and can include sternal rewiring, mediastinal irrigation, negative-pressure wound therapy (NPWT) dressing or repair with flaps. We reviewed changes in our management of DSWI and outcomes.


METHODS
Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, 5472 underwent cardiac surgery at St Vincent's Hospital, Melbourne, and 42 were identified as developing DSWI requiring re-operation between June 2002 and September 2014. Data were collected pertaining to risk factors for DSWI, management strategies and outcomes. Patients were compared from a period prior to NPWT dressing use (June 2002-February 2006, n = 14) and since the NPWT has been used regularly in the management of DSWI (from March 2006, n = 28). Patients were also compared based on the requirement for flap closure of their sternal wound.


RESULTS
Because of the widespread use of NPWT dressings, there is a trend towards fewer sternal infections requiring flap closure (25 versus 42.8%) and less post-operative complications after definitive closure (7.1 versus 28.6%). Before and after widespread NPWT use, patients require similar number of re-operations before closure and have no significant differences in time to definitive closure or length of hospital stay.


CONCLUSIONS
The use of NPWT dressings as a bridge to definitive closure may reduce the need for more burdensome flap reconstruction, does not delay definitive reconstruction or prolong hospital stay and may reduce post-reconstruction complications requiring re-operation.
Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Sarah
http://orcid.org/0000-0001-8109-6507
S
Lonie
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Jane
J
Hallam
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Michael
M
Yii
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Philip
P
Davis
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Andrew
A
Newcomb
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Ian
I
Nixon
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Alexander
A
Rosalion
Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Sophie
S
Ricketts
D000368:Aged; D001315:Australia; D006348:Cardiac Surgical Procedures; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000706:statistics & numerical data* / Q000639:trends; D009520:New Zealand; D010818:Practice Patterns, Physicians' / Q000639:trends*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data / Q000639:trends; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013524:Surgical Flaps / Q000706:statistics & numerical data / Q000639:trends; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome; D014945:Wound Healing
negative-pressure wound therapy; sternotomy; surgical wound infection; vacuum-assisted closure; wound closure technique