Deep sternal wound infection (DSWI), also known as post-sternotomy mediastinitis, is a potentially devastating complication following cardiac surgery, as it is associated with a significant increase in patient morbidity and mortality, prolonged hospitalization, and heavy economic burden. 1-3 DSWI is prevalent in 2% of patients following cardiac surgery and up to 8% in high-risk patients, with mortality rates as high as 40%-47% in the last 50 years 4-6 and significant impacts on patient outcomes. [7][8][9][10][11][12][13][14][15][16][17][18] Current treatment includes negative pressure wound therapy, which can serve both as an adjuvant therapy to treat DSWI as well as bridge these patients to final surgical closure. 19,20 In large and complicated sternal defect cases, surgical approaches may be warranted and include wound reconstruction by muscle flaps, most commonly through bilateral pectoralis muscle as sliding or "turn over" techniques, or by a rectus abdominus muscle or omental flap. [21][22][23][24] We present here the novel modified sternoplasty technique for treating severe DSWI following cardiac surgery, which involves a unique method for sternal reconstruction combined with the use of bilateral pectoralis muscle flaps. METHODSBetween September 2010 and January 2020, 68 patients following cardiac surgery (2.5% of patients, which is similar to levels reported globally) [7][8][9][10][11][12][13][14][15][16][17][18] developed DSWI according to the Center for Disease Control definitions, 25 with wide sternal dehiscence and total exposure of the heart and great vessels. These patients failed to heal with conservative treatment, and therefore underwent the modified sternoplasty surgery.
Background and Aim: Deep sternal wound infection (DSWI) is a serious complication following cardiac surgery, and demands early intervention as any delay in diagnosis and management may lead to increased morbidity and mortality. DSWI is associated with increased length of hospitalization (LOH) and economic burden in this patient population. The aim of this study was to determine predictors for increased length of hospitalization in patients who underwent the Modified Sternoplasty technique for deep sternal wound infection following cardiac surgery. Methods: A retrospective study was undertaken on data from patients who underwent the Modified Sternoplasty surgery for DSWI between September 2010 and January 2020. Patients' characteristics that were recorded included medical history, type of the original heart surgery, length of hospitalizations, and risk factors including hyperlipidemia, diabetes mellitus and hypertension, and morbidity and mortality rates following the Modified Sternoplasty.Results: Sixty-eight patients underwent the Modified Sternoplasty surgery with an average length of hospitalization of 24.63 + 22.09 days. Multivariable analysis showed that only gender was considered a predictor of length of hospitalization when controlling for comorbidities, with average length of hospitalization longer for women than men (35.4 vs. 20.9, p = .04). Conclusion:The Modified Sternoplasty surgery is a novel surgical technique for managing DSWI complicated by sternal dehiscence with exposed heart and great vessels. Female gender was associated with increased length of hospitalization in our patient cohort, with average length of hospitalization for women almost twice that of males.
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