Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach

Abstract

The aim of this article is to present the importance of astructured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41men and 13women with an average age of 65.1years, who developed aDSWI after acardiac surgical intervention during the period 2003-2016. The treatment strategy included athorough debridement including the removal of indwelling foreign material, the reconstruction with astable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for adefect coverage with agood blood supply and mandatory avoidance of dead spaces. Atotal of 146operations were necessary (average 2.7operations/patient, range 1-7operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5changes, standard deviation, SD± 5.6 changes over 22days, SD± 23.9days, change interval every 3-4days in 40.7% of the cases). In 33patients abilateral myocutaneous pectoralis major flap was used, in 4patients avertical rectus abdominis myocutaneous (VRAM) flap and in 7patients both were carried out. Atotal of 43osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30days) or in the later course. Of the patients 47 (87.1 %) could be discharged with acleansed infection. In 2patients the implant was removed after 2years due to loosening.