Treatment Of Sternal Osteomyelitis Research Articles

Treatment of Sternal Osteomyelitis: Economic Considerations

Objectives: Sternal osteomyelitis is a life threatening complication after sternotomy with an incidence between 0.8–8%. The treatment is challenging and requires a complex and expensive multidisciplinary therapy involving cardiac and plastic surgeons. For the first time we evaluate the exact costs of the treatment and its revenue by the German DRG-System.

Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game

A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.

Transomental Titanium Plates for Sternal Osteomyelitis in Cardiac Surgery

Wound infection is a devastating complication resulting in a high mortality rate from 7% to 80%. The risk of recurrences depends on the depth and the extension of the infection. We present our experience of omentoplasty using transomental sternal plates. Five patients (two females, mean age 61.2 ± 8.3 years) had severe osteomyelitis requiring radical sternectomy and omental flap transposition. In three cases (60%), the sternal manubrium was completely removed: in case of upper sternectomy, chest wall stability was achieved without metallic bars; in two cases chest wall stability required the use of three metallic plates for each patient (STRATOS SYSTEM) fixed on the second, third, and fourth ribs. The plates were passed through the omental flap to obtain a partial cover of the devices. No patient had abdominal complications. One patient had postoperative dehiscence of the superficial wound that was treated by VAC therapy for 30 days. The length of hospital stay was 65.2 ± 45.2 days. All patients had complete wound healing and are alive after 24.0 ± 21.4 months. Omental flap transposition represents a good option in the treatment of sternal osteomyelitis. Partial or total sternal manubrium preservation and fixation are essential for the restoration of sternal stability. The use of transomental titanium plates provides chest wall stabilization when extensive sternal resection is required.

Split Turnover Pectoralis Muscle Flap for the Treatment of Sternal Osteomyelitis

Split Turnover Pectoralis Muscle Flap for the Treatment of Sternal Osteomyelitis

Split Turnover Pectoralis Muscle Flap for the Treatment of Sternal Osteomyelitis

Split Turnover Pectoralis Muscle Flap for the Treatment of Sternal Osteomyelitis

Treatment of sternal osteomyelitis with the pectoralis major myocutaneous flap

Treatment of sternal osteomyelitis with the pectoralis major myocutaneous flap

Interaction of Itraconazole and Digoxin

A 69-year-old man who had been taking digoxin for 2.5 years developed an elevated serum concentration of digoxin in association with digoxin toxicity (characterized by nausea and vomiting) 9 days after the addition of itraconazole to his regimen for the treatment of sternal osteomyelitis. Coadministration of itraconazole resulted in a statistically significant increase in the half-life of digoxin that necessitated a reduction of the digoxin dose by almost 60%. We thus recommend that patients receiving itraconazole and digoxin concomitantly have serum levels of digoxin monitored frequently. In addition, these patients should be carefully questioned about nonspecific gastrointestinal symptoms, which may indicate early digoxin toxicity.