title: Titanium plate fixation versus conventional approach in the treatment of deep sternal wound infection.
abstract: BACKGROUND
  Deep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost. Sternal titanium plate fixation could be an effective approach to treat DSWI. We sought to compare the effectiveness of titanium plate fixation with conventional approach in the treatment of DSWI.
  
  
  METHODS
  Retrospective data was analyzed from consecutive patients with DSWI post cardiac surgery who received either titanium plate fixation (sternal plate group) or conventional treatment with sternal debridement and rewiring (control group). Pre-operative risk factors and post-operative clinical outcome were compared between the 2 groups.
  
  
  RESULTS
  A total of 36 patients (mean age 65.0 ± 8.6, 63.9 % male) with DSWI were in the sternal plate group whereas 26 patients (mean age 64.0 ± 13.4, 65.4 % male) were in the control group. The mean follow-up period was 15.92 months. The major pre-operative comorbidities were comparable between the 2 groups. The rate of receiving multiple debridement procedures (≥ 3) was significantly lower in the sternal plate group (5.6 % vs. 26.9 %, P = 0.03). Patients in the sternal plate group had no treatment failure, whereas 42.3 % of patients in the control group had treatment failure requiring muscle flaps reconstruction by plastic surgery (0 % vs. 42.3 %, P < 0.001). There was a trend of lower in-hospital mortality (11.1 % vs. 19.2 %, P = 0.47) in the sternal plate group.
  
  
  CONCLUSIONS
  Compared to conventional treatment, titanium plate fixation appears to have favorable clinical outcome.
authors.affiliation: Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada. shaohua.wang@albertahealthservices.ca.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Wang
mesh_terms: D000368:Aged; D001860:Bone Plates; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003646:Debridement / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D014025:Titanium; D017211:Treatment Failure
chemical_list: D014025:Titanium
keywords: Sternum; Wound infection