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

Abstract

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.