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Ann Thorac Surg 1985;40:214-223
© 1985 The Society of Thoracic Surgeons

Articles

A Survey of 77 Major Infectious Complications of Median Sternotomy: A Review of 7,949 Consecutive Operative Procedures

Eugene A. Grossi, M.D., Alfred T. Culliford, M.D., Karl H. Krieger, M.D., David Kloth, B.S., Robert Press, M.D., F. Gregory Baumann, Ph.D.*, Frank C. Spencer, M.D.

From the Division of Cardiothoracic Surgery, Department of Surgery, New York University Medical Center, New York, NY.

* Address reprint requests to Dr. Baumann, Room 532, CME Bldg, 520 First Ave, New York, NY 10016

Sternal wound infections developed following 77 (0.97%) of 7,949 operative procedures involving median sternotomy at New York University Medical Center from 1976 to 1984. Risk factors associated with the development of a sternal wound infection included combined revascularization and valve replacement, early reexploration for bleeding, prolonged low cardiac output syndrome, and prolonged ventilatory support (greater than 24 hours). Concomitant infection at other sites with the same organism as cultured from the sternum was present in 42% of the patients.

Thirty-seven patients (48%) were treated with radical debridement followed by closed antibiotic irrigation. In 31 other patients (40%), the wounds were debrided and left to heal by open granulation. Both initial treatments had equally high success rates (78.4% and 74.2%, respectively). However, the open granulation method resulted in a hospital stay that was an average of 10 days longer than the closed antibiotic irrigation method. Muscle flaps were used to expedite healing of open granulation in 9 patients.

Analysis of the results of different treatment strategies revealed that if debridement was accomplished within 20 days of the initial cardiac procedure, 76% of the patients could be successfully treated with closed antibiotic irrigation. Conversely, if treatment was delayed for longer than 20 days, 81% of the patients were treated with open granulation (p < 0.001). Also noted was an inverse relationship between the serum blood urea nitrogen (BUN) level and the success rate of initial treatment with closed antibiotic irrigation. Patients with a serum BUN level of less than 40 mg/dl at the time of debridement had a 90% success rate as opposed to a success rate of 38% when the BUN level was 40 mg/dl or greater.

The data presented suggest the following conclusions. Early diagnosis is crucial to successful treatment of sternal wound infection. When diagnosis can be established within 20 days, 80% of infections can be eradicated by the simple approach of debridement and closed antibiotic irrigation. When diagnosis is delayed, however, prompt debridement followed by muscle flaps is the procedure of choice. Open granulation alone, while successful, unnecessarily prolongs the hospital course.




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G. Tavilla, J. A. M. van Son, A. F. Verhagen, and L. K. Lacquet
Modified Robicsek technique for complicated sternal closure
Ann. Thorac. Surg., November 1, 1991; 52(5): 1179 - 1180.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
L. A. Sargent, A. E. Seyfer, J. Hollinger, R. M. Hinson, and G. M. Graeber
The healing sternum: A comparison of osseous healing with wire versus rigid fixation
Ann. Thorac. Surg., September 1, 1991; 52(3): 490 - 494.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
E. G. Ford, C. E. Baisden, M. L. Matteson, and A. L. Picone
Sepsis after coronary bypass grafting: Evidence for loss of the gut mucosal barrier
Ann. Thorac. Surg., September 1, 1991; 52(3): 514 - 517.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
P. Vanleeuw, D. Roux, G. Fournial, P. Dalous, Y. Glock, P. Puel, F. Joffre, and H. Rousseau
Early postoperative sternal approximation after ITA harvesting: Computed tomographic evaluation
Ann. Thorac. Surg., September 1, 1991; 52(3): 518 - 522.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
L. J. Kohman, J. H. Auchincloss, R. Gilbert, and M. Beshara
Functional results of muscle flap closure for sternal infection
Ann. Thorac. Surg., July 1, 1991; 52(1): 102 - 106.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
K. S. Ulicny Jr, L. F. Hiratzka, R. B. Williams, G. L. Grunkemeier, J. B. Flege Jr, C. B. Wright, G. M. Callard, D. L. Mitts, and E. J. Dunn
Sternotomy infection: Poor prediction by acute phase response and delayed hypersensitivity
Ann. Thorac. Surg., December 1, 1990; 50(6): 949 - 958.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
T. L. Demmy, S. B. Park, G. A. Liebler, J. A. Burkholder, T. D. Maher, D. H. Benckart, G. J. Magovern Jr, and G. J. Magovern Sr
Recent experience with major sternal wound complications
Ann. Thorac. Surg., March 1, 1990; 49(3): 458 - 462.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
F. D. Loop, B. W. Lytle, D. M. Cosgrove, S. Mahfood, M. C. McHenry, M. Goormastic, R. W. Stewart, L. A. R. Golding, and P. C. Taylor
Sternal wound complications after isolated coronary artery bypass grafting: Early and late mortality, morbidity, and cost of care
Ann. Thorac. Surg., February 1, 1990; 49(2): 179 - 187.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
N. T. Kouchoukos, T. H. Wareing, S. F. Murphy, C. Pelate, and W. G. Marshall Jr
Risks of bilateral internal mammary artery bypass grafting
Ann. Thorac. Surg., February 1, 1990; 49(2): 210 - 219.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
D. D. Glower, J. M. Douglas Jr, J. W. Gaynor, R. N. Jones, and H. N. Oldham Jr
Candida mediastinitis after a cardiac operation
Ann. Thorac. Surg., January 1, 1990; 49(1): 157 - 163.
[Abstract] [PDF]

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R. Shafir, J. Weiss, O. Herman, and A. Elami
The Danger in Skin Grafting the Bare Mediastinum After Sternectomy for Postcoronary Bypass Dehiscence
Ann. Thorac. Surg., October 1, 1989; 48(4): 584 - 586.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
W. Terranova and F. A. Crawford Jr
Treatment of median sternotomy wound infection and sternal necrosis in an infant
Ann. Thorac. Surg., July 1, 1989; 48(1): 122 - 123.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
R. F. Di Marco Jr, M. W. Lee, S. Bekoe, K. J. Grant, G. F. Woelfel, and R. V. Pellegrini
Interlocking figure-of-8 closure of the sternum
Ann. Thorac. Surg., June 1, 1989; 47(6): 927 - 929.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. A. Johnson, W. E. Gall, A. E. Gundersen, and T. H. Cogbill
Delayed primary closure after sternal wound infection
Ann. Thorac. Surg., February 1, 1989; 47(2): 270 - 273.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
R. M. Bojar, D. D. Payne, A. B. Sheffield, H. Rastegar, J. J. Stetz, and R. J. Cleveland
Successful Repair of Postoperative Ascending Aortic Mycotic False Aneurysms Using Circulatory Arrest
Ann. Thorac. Surg., August 1, 1988; 46(2): 182 - 186.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
R. M. Stiegel, M. E. Beasley, J. D. Sink, T. R. Hester, R. A. Guyton, A.-M. Perrella, and W. H. Williams
Management of Postoperative Mediastinitis in Infants and Children by Muscle Flap Rotation
Ann. Thorac. Surg., July 1, 1988; 46(1): 45 - 46.
[Abstract] [PDF]


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