SURGICAL TREATMENT STRATEGIES OF DEEP STERNAL WOUND INFECTION FOLLOWING CARDIAC SURGERY.

BACKGROUND

Deep sternal wound infection (DSWI) is a life-threatening complication following cardiac surgery. This study aimed to evaluate different surgical treatment approaches for DSWI.

METHODS

We retrospectively analysed the treatment outcomes of 70 DSWI patients treated at two hospitals within the same region. Hospital 1 admitted patients shortly after the onset of complications, applying surgical debridement supplemented by negative pressure wound therapy (NPWT), with rewiring used predominantly to close the sternal wound. Patients in Hospital 2 experienced delayed hospitalization and underwent simultaneous surgical treatment and reconstruction, most often using pectoralis major flap reconstruction. The duration of hospitalization, 30-day and 1-year mortality rates, and recurrence of infection were evaluated.

RESULTS

The incidence of DSWI following cardiac surgery was 1.5%. Staphylococcus spp. was the most commonly isolated pathogen. The median treatment delay for patients in Hospital 1 was 1 day [IQR: 1-2], compared to 13 days [IQR: 8-24] in Hospital 2. Consequently, patients in Hospital 2 often had significant sternal defects post-debridement, necessitating flap reconstruction. In Hospital 1, prompt surgical intervention allowed preservation of a substantial portion of the sternum, with NPWT facilitating rapid control of acute inflammation. Sternal reconstruction predominantly involved rewiring, which restored chest stability. The mean hospitalization duration was 25 days [IQR: 16-30] in Hospital 1 and 22 days [IQR: 16-29] in Hospital 2. 30-day mortality rates were 5% in Hospital 1 and 6% in Hospital 2, with 1-year mortality rates of 10.5% and 4.3%, respectively. Infection recurrence rates were 15% in Hospital 1 and 24% in Hospital 2.

CONCLUSIONS

The timing of surgical debridement is crucial in managing DSWI. When sufficient sternal tissue is preserved, rewiring is a viable option. Flap reconstruction is effective, particularly in cases involving extensive bone destruction.