Document Detail


Delayed primary closure of deep sternal wound infections.
MedLine Citation:
PMID:  8885104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Deep infections of the sternum and mediastinum, with prevalence of osteomyelitis and tissue necrosis, were documented in 38 of 8,056 patients (0.47%) who underwent open-heart surgery (1975 through 1994) in our service. The incidences of insulin-dependent diabetes, obesity, and emergency surgery in these patients were relatively high at 39%, 47%, and 18%, respectively. Treatment with antibiotics, débridement, open packing, and delayed closure was administered to 33 patients (87%), with 100% healing. There were no deaths in this group. Flap reconstruction was indicated in 5 gravely ill patients (13%) in whom excessively large wound defects did not allow reapproximation. There were 2 deaths in this group, and 4 reoperations were necessary in the surviving patients because of sequelae arising from flap reconstruction. The overall mortality was 5.3% and the median period of hospitalization was 29 days. The length of stay decreased substantially over the period of this study (median = 21 days, year > or = 1987). Accordingly, we believe that treatment of deep sternal infections with delayed primary closure is safe and effective. Also, given the increased potential for complications and long-term sequelae, we believe that flap reconstruction should be used selectively and should be limited to patients with large defects, uncontrolled mediastinal bleeding, or both.
Authors:
A Zacharias; R H Habib
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  23     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  1996  
Date Detail:
Created Date:  1997-01-28     Completed Date:  1997-01-28     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  211-6     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, St. Vincent Medical Center, Toledo, Ohio 43608-2691, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / administration & dosage
Cardiac Surgical Procedures*
Debridement
Diabetes Mellitus, Type 1 / complications
Emergencies
Female
Humans
Male
Mediastinum*
Methods
Middle Aged
Necrosis
Obesity / complications
Osteomyelitis / etiology
Reoperation
Sternum*
Surgical Flaps
Surgical Wound Infection / mortality,  pathology,  surgery*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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