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Ann Thorac Surg 1999;67:595
© 1999 The Society of Thoracic Surgeons

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Correspondence

Deep wound infection following minithoracotomy for coronary bypass grafting

^a Klinik f. Herz-, Thorax Gefäßchirurgie, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, D-55101 Mainz, Germany

We read with great interest the article by Pagni and colleagues [1] about serious wound infections after minimally invasive coronary artery bypass graft procedures. We have seen the same complication in a 60-year-old man with insulin-dependent diabetes undergoing minimally invasive revascularization of the left anterior descending coronary artery with an internal thoracic artery graft through an anterolateral thoracotomy. After deep opening of the incision on postoperative day 5, a necrotizing infection of the pectoralis major was encountered with positive culture for Staphylococcus aureus. A staged dissection of pectoralis major muscle and subcutaneous tissue supported by intravenous antibiotics achieved a healing by secondary intention.

In our opinion local ischemia of the thoracic interspaces or interruption of the intraarterial collateral pathway after dissection of the internal thoracic artery are probably less relevant for this type of infection than the development of a deep local hematoma with secondary bacterial contamination or a contusional trauma to the adjacent muscle caused by the tendency to perform a more limited approach. The clinical relevance of a deep wound infection that involves the underlying muscular layers and poses the complication of a secondary infection of the pleural cavity cannot be overemphasized. Because this type of infection remains clinically silent until considerable local destruction has occurred, monitoring of C-reactive protein and leukocytes is probably the best way to detect a deep wound infection early. Use of a subpectoral drain is a cheap and effective prophylactic aid that should be considered for the minithoractomy.

The small anterior thoracotomy has been vigorously promoted both by the media and the medical industry. With the propagation of off-pump coronary artery bypass grafting for multiple-vessel revascularization, we hope that cardiac surgeons will become aware of the classic median sternotomy as an excellent access for single arterial grafting of the left anterior descending coronary artery in beating heart procedures.

References

1. Pagni S., Salloum E.J., Tobin G.R., VanHimbergen D.J., Spence P.A. Serious wound infections after minimally coronary bypass procedures. Ann Thorac Surg 1998;66:92-94.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ulrich Hake Michael Hilker Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hake, U. Articles by Hilker, M. Search for Related Content PubMed PubMed Citation Articles by Hake, U. Articles by Hilker, M. Related Collections Related Article