Objectives: To evalute a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality.
Methods: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis was used to determine preoperative and peri-operative risks factors for overall mortality in SWI patients.
Results: Out of 5,905 procedures, 146 sternal wound infection (SWI) were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1% and 3.3%. Pathogens involved were S. Epidemidis ( 44.5%), S. Aureus (31.5%) and Gram negative rods (21.2%). Re-operation was required in 130/146 patients. Mean time to the first reintervention was 17.3 days (Std dev : 12 d). Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), rewiring and mediastinal lavage (52 patients), and partial/complete sternectomy (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI was 4.4% and 5.5% (p=0.78). For patients with deep SWI, 90-d mortality was 14.5% (p< .0001).
Conclusions: Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.