EARLY INTERVENTION AND AGGRESSIVE MANAGEMENT OF INFECTED MEDIAN STERNOTOMY INCISION - A REVIEW OF 2242 OPEN-HEART PROCEDURES

Infected median sternotomy following open-heart surgery is a devastati ng complication with an incidence Df 0.4 to 5 per cent and mortality a s high as 80 per cent. Management varies from irrigation, debridement, closure with muscle, and skin flaps. We present our experience of ear ly intervention and aggressive single-stage operative management. A re trospective chart review of all open-heart surgery patients was conduc ted from September 1984 through September 1994. Of the 2242 patients, 52 had infected median sternotomy incisions (2.3% incidence). The mean length of stay for reconstructive procedures was 18 days. The median interval to detection was 15 days, whereas the median interval to inte rvention was 4 days. There were five (6.8%) failed procedures and nine (12.3%) staged procedures. There were six deaths (11.5% incidence), o ne prior to receiving operative intervention. There was one false aneu rysm. Single-stage reconstruction is safe, with results better than mu ltistage procedures. It may be safely performed with a high success ra te (93%). Early recognition and intervention significantly decreases l ength of stay.