| Prospective trial of catheter irrigation and muscle flaps for sternal wound infection. | |
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MedLine Citation:
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PMID: 9564925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Sternal wound infection is a relatively rare but potentially devastating complication of open heart operations. The most common treatments after debridement are rewiring with antibiotic irrigation and muscle flaps. Here we present the results of a prospective trial to determine the appropriate roles of closed-chest catheter irrigation and muscle flap closure for sternotomy infection and to assess the effect of internal mammary artery bypass grafting on the outcome of each treatment modality. METHODS: Between 1990 and 1994, 5,658 sternotomies were performed at the University of Washington Medical Center. Sternal dehiscence occurred in 43 patients, 25 of whom had infection (overall incidence, 0.44%). Because of the infrequency of this complication, a prospective, randomized trial was developed in which the initial approach to sternal dehiscence was rewiring and catheter irrigation. Muscle flaps were used as the primary treatment if the sternum could not be restabilized or as secondary treatment if catheter irrigation failed. Wound resolution, length of hospital stay, and complications were evaluated. RESULTS: Sterile dehiscences were successfully closed with irrigation in 17 of 18 patients; the other patient required flap closure. Of the 25 patients with infection, 19 had irrigation and 6, closure with flaps primarily. In the group of infected patients, 17 of the 19 who received irrigation also had internal mammary artery bypass grafting. Irrigation failed in 15 (88.2%) of these 17 patients, and salvage was accomplished with muscle flap closure. All 6 patients with infection who were closed primarily with muscle flaps had a successful outcome. Hospitalization averaged 10.2 days when muscle flaps were used primarily and 14.3 additional days for unsuccessful irrigation. When irrigation was successful, the hospital stay averaged 11.2 days. CONCLUSIONS: Catheter irrigation should be reserved for patients without infection or patients with infection but without internal mammary artery bypass grafts in whom dehiscence occurs less than 1 month after sternotomy. All others should have closure with muscle flaps. |
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Authors:
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R P Rand; R P Cochran; S Aziz; B O Hofer; M D Allen; E D Verrier; K S Kunzelman |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 65 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 1998 Apr |
Date Detail:
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Created Date: 1998-05-14 Completed Date: 1998-05-14 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1046-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Washington School of Medicine, Seattle 98195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Bacterial Agents
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administration & dosage,
therapeutic use* Bone Wires Cardiac Surgical Procedures / adverse effects Catheters, Indwelling* Combined Modality Therapy Debridement Hospitalization Humans Internal Mammary-Coronary Artery Anastomosis Irrigation / instrumentation* Length of Stay Muscle, Skeletal / transplantation* Omentum / transplantation Postoperative Complications Prospective Studies Sternum / surgery* Surgical Flaps* Surgical Wound Dehiscence / drug therapy, surgery Surgical Wound Infection / drug therapy*, surgery Thoracotomy / adverse effects* Treatment Outcome Wound Healing |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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