DELAYED PRIMARY CLOSURE OF DEEP STERNAL WOUND INFECTIONS

Deep infections of the sternum and mediastinum, with prevalence of ost eomyelitis and tissue necrosis, were documented in 38 of 8,056 patient s (0.47%) who underwent open-heart surgery (1975 through 1994) in our service. The incidences of insulin-dependent diabetes, obesity, and em ergency surgery in these patients were relatively high at 39%, 47%, an d 18%, respectively Treatment with antibiotics, debridement open packi ng, and delayed closure was administered to 33 patients (87%), with 10 0% healing. There were no deaths in this group. Flap reconstruction wa s indicated in 5 gravely iii patients (13%) in whom excessively large wound defects did not allow reapproximation. There were 2 deaths in th is group, and 4 reoperations were necessary in the surviving patients because of sequelae arising from flap reconstruction. The overall mort ality was 5.3% and the median period of hospitalization was 29 days. T he length of stay decreased substantially over the period of this stud y (median = 21 days, year greater than or equal to 1987). Accordingly we believe that treatment of deep sternal infections with delayed prim ary closure is safe and effective. Also, given the increased potential for complications and long-term sequelae, we believe that flap recons truction should be used selectively and should be limited to patients with large defects, uncontrolled mediastinal bleeding or both.