| Algorithm for primary closure in sternal wound infection: a single institution 10-year experience. | |
| | |
MedLine Citation:
|
PMID: 18082415 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: To evaluate 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 were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality. RESULTS: Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3+/-12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p=0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p<0.0001). 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. |
| | |
Authors:
|
Alain Jean Poncelet; Benoit Lengele; Bénédicte Delaere; Francis Zech; David Glineur; Jean-Christophe Funken; Gebrine El Khoury; Philippe Noirhomme |
Related Documents
:
|
17165035 - Simplified wound care and earlier wound recovery without closed suction drainage in ele... 9564925 - Prospective trial of catheter irrigation and muscle flaps for sternal wound infection. 9010415 - Classification of previously unclassified cases of craniosynostosis. 12972935 - Promoting healing with recombinant human platelet-derived growth factor--bb in a previo... 12142185 - Significant merits of a fibrin sealant in the presence of coagulopathy following paedia... 18029325 - Clinical results versus subjective improvement with anterior transposition in cubital t... |
Publication Detail:
|
Type: Evaluation Studies; Journal Article Date: 2007-12-21 |
Journal Detail:
|
Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 33 ISSN: 1010-7940 ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2008 Feb |
Date Detail:
|
Created Date: 2008-01-21 Completed Date: 2008-08-19 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
|
Languages: eng Pagination: 232-8 Citation Subset: IM |
Affiliation:
|
Department of Cardio-Vascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium. poncelet@chir.ucl.ac.be |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Algorithms* Bone Wires Cardiac Surgical Procedures / adverse effects* Debridement Epidemiologic Methods Female Humans Length of Stay Male Middle Aged Reoperation / adverse effects, statistics & numerical data Sternum / surgery* Surgical Flaps Surgical Wound Infection / epidemiology, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Improved results with single-stage total correction of Taussig-Bing anomaly.
Next Document: Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgica...