STERNAL WOUND-INFECTION - OUR EXPERIENCE WITH 200 CASES

More than 200 patients with sternal wound infections have been treated in the Plastic Surgery Department of our Medical Center over the year s 1984-1993. Most of these were referrals from other hospitals. In rec ent years, the cases have become more severe, partially due to the fac t that cardiac surgeons tend to operate older and sicker patients more readily than they previously did. 80% of these were post coronary byp ass surgery, and the others heart and heart-lung transplants, repair o f congenital heart anomalies, valve replacements etc. Several of the c ases were cardiac surgery re-do's. Risk factors for developing this co mplication, such as diabetes, obesity, technical errors of sternal inc ision, prolonged intubation, the use of aortic balloon, etc. will be d iscussed. Many of our earlier patients had chronic fistulae following conservative therapy with old treatment modalities. In recent years, p atients are usually referred at the acute stage. Most patients undergo removal of sternum and ribs. Previously, reconstruction included main ly transfer of the rectus ahdominis muscle, whereas lately the pectora lis muscles is utilized. Omentum was used in only one case. The import ance of pre-operative imaging procedures has been thoroughly studied i n our series. Especially important is the definition of the extent of the infection, and localization of foreign bodies causing chronic infe ctions, such as suture material, epicardial electrodes etc. A change i n infectants has also been noticed. In the first half of the study per iod, Pseudomonas aeruginosa com prised at least 40%. In the second hal f, Staphylococcus epidermidis was the predominant and most difficult o rganism to handle; 15% of our patients had recurrent infections and ne eded further surgery, up to 6 operations in one case; 3 patients succu mbed to rupture of exposed bypasses. Removal of sternum and ribs cause d no functional problems.