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Ann Thorac Surg 2004;78:1659-1664
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Sternal Preservation: A Better Way to Treat Most Sternal Wound Complications After Cardiac Surgery

^a Division of Cardiothoracic Surgery, The Oregon Clinic PC, Portland, Oregon, USA
^b Earle A. Chiles Research Institute, Portland, Oregon, USA
^c Infectious Disease Department, Providence Portland Medical Center, Portland, Oregon, USA
^d Surgery Department (Plastic), Providence Portland Medical Center, Portland, Oregon, USA
^e Medical Data Research Center, Providence Health System, Portland, Oregon, USA

Accepted for publication April 27, 2004.

^* Address reprint requests to Dr Douville, The Oregon Clinic PC, 507 NE 47th Ave, Portland, OR, USA 97213
ecdouville{at}orclinic.com

BACKGROUND: Postcardiotomy sternal wound complications remain challenging. The prevailing approach for deep sternal wound infection of débridement and flap coverage without osseous closure makes subsequent reoperation difficult.

METHODS: An analysis of all patients undergoing cardiac surgery at a single institution between 1986 and 2001 was conducted. Prospective data collection and chart review were used to compare different treatment strategies for sternal complications.

RESULTS: Of 5337 patients, 122 had sternal wound complications (2.2%) comprising 15 (0.3%) uninfected dehiscences (El Oakley class 1), 45 (0.8%) superficial infections (El Oakley class 2A), and 62 (1.1%) deep sternal wound infections (El Oakley class 2B). Thirty-two patients with deep sternal infection were treated by débridement, rewiring, and delayed primary closure. There were initial treatment failures in 6 patients (18.8%) and ultimate failures in 2 patients (6.3%), both of whom died. One of these patients had previously received external beam radiation after a radical mastectomy for breast cancer. Median length of stay was 32 days and median time to wound healing was 85 days. Twenty-five patients were managed by muscle flap coverage without sternal reclosure. There were 6 initial treatment failures (24%) but no ultimate failures or deaths (p = NS). Median length of stay was 31 days and median infection time was 161 days.

CONCLUSIONS: In patients with postcardiotomy deep sternal wound infection without previous chest radiation, débridement, rewiring, and delayed skin closure is effective. It offers a shorter healing time and probably makes late cardiac reoperation safer. We propose an algorithm for the management of poststernotomy complications.

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