A new classification of post sternotomy dehiscence

Abstract

The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality. A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds. The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful. We propose a new classification based only on the anatomical changes following sternotomy dehiscence and chronic wound formation separating it in four types according to the deepness and in two sub-groups according to the vertical extension based on the inferior insertion of the pectoralis major muscle.

Post-sternotomy mediastinitis in the modern era

“…These definitions clarify the site of infection, but do not correlate with the extension beyond the sternum, which is important in determining the variety of surgical techniques for sternal closure and/or reconstruction. Anger and colleagues created a classification based on the depth and anatomical extent of the wounds, in recognition of the additional difficulty of reconstructing the lower portion of the sternal wound when it extends below the insertion of the lower border of the pectoralis major muscle. They also defined if the wound is partial or total in relation to its vertical extent and position, using as a reference the inclusion of the lower margin of the pectoralis major muscle.…”

Mediastinitis in the intensive care unit patient: a narrative review

“…The most recent classification of DSWI is based on the depth and extent of the infectious process and correlates with the severity of the infection. A Type I infection involves the skin and subcutaneous tissues only, Type II either the sternum or ribs, Type III includes bone loss of either the sternum or ribs and finally Type IV, when the mediastinum itself is affected [4].…”

S3-Leitlinie (Langversion) „Management der Mediastinitis nach herzchirurgischem Eingriff“

“…Die im Folgenden zusammengestellte Empfehlungsbegründung basiert nicht auf der systematischen Literaturrecherche im Einzugsgebiet der Leitlinie, sondern stellt eine narrative Zusammenfassung basierend sowohl auf der Literatur, [59][60][61][62][63][64][65] die durch die Autoren unsystematisch zusammengestellt wurde, als auch auf deren Expertenmeinung dar.…”

“…In der Literatur finden sich insgesamt 7 Klassifikationen zur PSM, [59][60][61][62][63][64][65] denen unterschiedliche Perspektiven zugrunde liegen und die bei PSM angewendet werden können (►Tabellen 5-11). Die international verbreitete Klassifikation des Centers for Disease Control and Prevention (CDC) unterteilt die postoperativen Wundinfektionen im Bereich der Sternotomie anhand der beteiligten Gewebsschichten.…”