STERNOTOMY INFECTIONS - STERNAL SALVAGE AND THE IMPORTANCE OF STERNALSTABILITY

OBJECTIVE: To review the management of sternal wound infections after cardiovascular surgery. DESIGN: Retrospective case study. SETTING: All management took place in a single tertiary-care university hospital. PATIENTS: Twenty-one consecutive patients seen over a 3-year period wh o had infected median sternotomy incisions after cardiovascular surger y. INTERVENTIONS: Surgical eradication of infection, including sternal debridement and rewiring or placement of vascularized muscle flaps, o r both. MAIN OUTCOME MEASURES: Resolution of infection and restoration of sternal stability. RESULTS: The development of sternal wound infec tion was found to be associated with sternal instability. In 12 of 17 patients treated initially with sternal debridement and rewiring the i nfection was cured. Vascularized muscle nap transfers were required to eradicate the infection in the remaining patients. CONCLUSIONS: Stern al debridement and rewiring is an effective initial treatment for ster nal wound infections in selected patients. Some patients may require p lacement of muscle naps for definitive treatment.