Abstract
Redo open-heart surgery and sternal reentry in patients with previous deep sternal wound infection (DSWI) and absence of sternal integrity can be a delicate and morbid task due the lack of a dissection plane between the heart and the surrounding soft tissues. Delayed sternal reconstruction and osteosynthesis with horizontal titanium plating fixation (Synthes) following vacuum assisted therapy (KCI) has recently been proposed and adopted for the treatment of DSWI. We present such a case of a patient who was successfully reoperated for valve replacement three years after coronary artery bypass grafting complicated by DSWI and initially treated with titanium plate fixation.
Highlights
Deep sternal wound infection remains a feared complication of cardiac surgery still associated with significant morbidity and mortality
Case report A 73–year old active patient underwent triple coronary artery bypass grafting (CABG) in 2005 at an outside hospital. This initially uneventful procedure was followed by a S.Aureus deep sternal wound infection (DSWI) which was referred to our center and managed with aggressive debridement, Vacuum Assisted Therapy/ Negative pressure wound therapy (VAC) therapy and delayed sternal wound reconstruction with horizontal titanium plate fixation (Figure 1) and pectoralis myocutaneous flaps
Literature on the subject remains scarce, and to our knowledge this is the first paper to report such a surgery in a patient previously managed with horizontal titanium fixation following DSWI
Summary
Introduction Deep sternal wound infection remains a feared complication of cardiac surgery still associated with significant morbidity and mortality. We have recently adopted the routine use of negative wound pressure therapy (VAC -KCI) [3-5] after initial wound debridement as a bridge to delayed chest wall reconstruction with horizontal titanium plate fixation (Synthes) [6].
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