Abstract
BackgroundDeep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost. Sternal titanium plate fixation could be an effective approach to treat DSWI. We sought to compare the effectiveness of titanium plate fixation with conventional approach in the treatment of DSWI.MethodsRetrospective data was analyzed from consecutive patients with DSWI post cardiac surgery who received either titanium plate fixation (sternal plate group) or conventional treatment with sternal debridement and rewiring (control group). Pre-operative risk factors and post-operative clinical outcome were compared between the 2 groups.ResultsA total of 36 patients (mean age 65.0 ± 8.6, 63.9 % male) with DSWI were in the sternal plate group whereas 26 patients (mean age 64.0 ± 13.4, 65.4 % male) were in the control group. The mean follow-up period was 15.92 months. The major pre-operative comorbidities were comparable between the 2 groups. The rate of receiving multiple debridement procedures (≥3) was significantly lower in the sternal plate group (5.6 % vs. 26.9 %, P = 0.03). Patients in the sternal plate group had no treatment failure, whereas 42.3 % of patients in the control group had treatment failure requiring muscle flaps reconstruction by plastic surgery (0 % vs. 42.3 %, P < 0.001). There was a trend of lower in-hospital mortality (11.1 % vs. 19.2 %, P = 0.47) in the sternal plate group.ConclusionCompared to conventional treatment, titanium plate fixation appears to have favorable clinical outcome.
Highlights
Deep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost
The pre-operative comorbidities including hypertension, hyperlipidemia, diabetes, body mass index, smoking, chronic obstructive pulmonary disease (COPD), chronic renal dysfunction and left ventricular ejection fraction were all comparable between the 2 groups
Studies have shown that risk factors of DSWI post cardiac surgery include prolonged intubation, bilateral internal mammary arteries use, diabetes, post-op bleeding, high body mass index (BMI) and combined surgery [4]
Summary
Deep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost. Sternal titanium plate fixation could be an effective approach to treat DSWI. We sought to compare the effectiveness of titanium plate fixation with conventional approach in the treatment of DSWI. Median sternotomy remains the most commonly used incision in patients undergoing cardiac surgery. Deep sternal wound infection (DSWI) is a serious complication post sternotomy. Rates of DSWI are relatively low (range 0.4 to 5.1 %) [1,2,3], it is associated with higher mortality and morbidities, prolonged hospital stay, and increased patient suffering and cost [4, 5]. Conventional treatment of DSWI includes wound debridement, wound vacuum therapy (VAC) and sternal rewiring [6].
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