A Survey of 77 Major Infectious Complications of Median Sternotomy: A Review of 7,949 Consecutive Operative Procedures

Grossi, Eugene A.; Culliford, Alfred T.; Krieger, Karl H.; Kloth, David; Press, Robert; Baumann, F.Gregory; Spencer, Frank C.

doi:10.1016/s0003-4975(10)60030-6

Cited by 299 publications

(133 citation statements)

References 16 publications

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“…After sternotomy, these forces can interfere with bony healing and cause serious complications [21][22][23] . An unstable sternotomy can increase postoperative sternal pain, which can lead to atelectasis and pneumonia, secondary to a decreased inspiratory effort [9] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

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AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

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Section: Discussionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

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“…aeruginosa. [7][8][9] So our regime of antibiotics containing teicoplanin and meropenem was justified to use as prophylaxis of all types of open Heart surgery. Glycopeptides have some adverse events particularly 'red man' syndrome and nephrotoxicity.…”

Section: Antibiotic Regimementioning

confidence: 99%

“…3,4 Staphylococcus aureus and Staphylococcus epidermidis are the most common culprit in post cardio-thoracic SSI. [5][6][7][8][9] Other micro-organisms, including diptheroides, aerobic and anaerobic streptococci and enteric gram-negative bacilli are also involved. [10][11][12] In an attempt to prevent both wound infections and prosthetic valve endocarditis cardiac surgery presently administer antibiotics to virtually all patients undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Teicoplanin and Meropenem Prophylaxis in Open Heart Surgery- Efficacy and Safety

Sarker

Biswas

et al. 2017

Cardiovasc. j.

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“…Until the 1980s the standard treatment of sternal wound infections was debridement and open granulation with secondary closure or closed catheter irrigation, but failure of treatment was common with mortality rates as high as 37.5% (15). The use of pectoral muscle flaps to treat severe and life-threatening sternal wound infections was introduced by Jurkiewicz et al in 1980 (16).…”

Section: Introductionmentioning

confidence: 99%

Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection

Eriksson

Huljebrant

Nettelblad

et al. 2011

Scandinavian Cardiovascular Journal

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Objective. Pectoral muscle flaps (PMF) are effective in terminating protracted sternal wound infections (SWI) but long-term outcome remains uncertain. Therefore, the aim of this study was to evaluate long-term outcome in patients treated with PMF. Design. Thirty-four of 263 patients revised because of deep SWI from 1991-2005 were treated with PMF. Of the 21 patients alive, 11 had left-sided, two right-sided and eight bilateral procedures. Sternal debridement without closure of the sternum was done in 17 patients. Nineteen of 21 patients responded to a questionnaire. Results. At follow-up on average 5.9 years (range 1.9-14.8 years) after surgery 63% (12/19) experienced unstable chest. Two thirds (12/18) reported problems carrying a grocery bag and 37% (7/19) had problems putting on a coat. Reduction of power and mobility was more common in the right arm and shoulder even in patients with left-sided PMF. Thirty-two percent (6/19) would have preferred alternative treatment if possible to avoid sternal instability even if healing had been substantially delayed. Conclusions. Surgery with PMF and sternal debridement was associated with long-term disability, which appeared to be significant in one third of the patients. The function of the right arm and shoulder was affected more often despite the majority of procedures being left-sided suggesting that loss of skeletal continuity of the chest wall is more disabling than loss of pectoral muscle function.

Original Publication: Jenny Eriksson, Inger Huljebrant, Hans Nettelblad and Rolf Svedjeholm, Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection, 2011, SCANDINAVIAN CARDIOVASCULAR JOURNAL, (45), 3, 174-180. http://dx.doi.org/10.3109/14017431.2011.563318 Copyright: Informa Healthcare http://informahealthcare.com/

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A Survey of 77 Major Infectious Complications of Median Sternotomy: A Review of 7,949 Consecutive Operative Procedures

Cited by 299 publications

References 16 publications

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Teicoplanin and Meropenem Prophylaxis in Open Heart Surgery- Efficacy and Safety

Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection

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