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Babulal Sethia
William J. Brawn
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Ann Thorac Surg 1998;66:296
© 1998 The Society of Thoracic Surgeons

Correspondence

Delayed sternal closure

Adrian J. Levine, FRCSa, Babulal Sethia, FRCSa, William J. Brawn, FRCSa

a Department of Cardiac Surgery, The Birmingham Children’s Hospital, Ladywood Middleway, Ladywood, Birmingham, B16 8ET, United Kingdom

e-mail: ajlevine{at}online.rednet.co.uk

To the Editor

We read with interest the article by Iyers and associates entitled "Outcomes After Delayed Sternal Closure in Pediatric Heart Operations: A 10-Year Experience" [1]. We agree that "delayed sternal closure ... is a safe and helpful procedure in infants and children with compromised cardiac output after repair of complex cardiac defects." In our institution, delayed sternal closure is routine management in many complex procedures in infancy. We routinely use two methods in delayed sternal closure: direct skin closure or a fenestrated polytetrafluoroethylene patch sutured to the skin edges. Closure of the chest is usually performed in the intensive therapy unit. We use as a routine antibiotic cover until chest closure and also perform mediastinal lavage with normal saline solution before closure. We take a microbiological swab of the mediastinum before closure. In our last 70 patients (mean time to closure, 1.7 days; range, 1 to 4 days), all the swabs have shown no growth; pus cells were seen in 19 of the 70. There was no correlation between the presence of pus cells and the length of time the chest was open or whether direct skin closure or polytetrafluoroethylene patch was used. There were no episodes of serious mediastinal infection.

We agree that delayed sternal closure is a safe and efficacious technique when used after complex congenital heart operations. This technique may be used with a low risk of postoperative infection.

References

  1. Iyer R.S., Jacobs J.P., de Leval M.R., Stark J., Elliott M.J. Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann Thorac Surg 1997;63:489-491.[Abstract/Free Full Text]




This Article
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Babulal Sethia
William J. Brawn
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