Cw. Raudat et al., EARLY INTERVENTION AND AGGRESSIVE MANAGEMENT OF INFECTED MEDIAN STERNOTOMY INCISION - A REVIEW OF 2242 OPEN-HEART PROCEDURES, The American surgeon, 63(3), 1997, pp. 238-241
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.