Pathological study of sternal osteomyelitis after median thoracotomy – A prospective cohort study

Abstract

Purpose Osteomyelitis of the sternum may arise either as a primary condition or secondary to median thoracotomy after cardiac surgery, with the latter being decidedly more frequent. Deep sternal wound infections appear as a complication of median thoracotomy in 0.2 to 4.4% of cases and may encompass the infection of the sternal bone. To date there are no exhaustive histopathological studies of the sternal osteomyelitis. Methods Our work group developed a surgical technique to remove the complete infected sternal bone in deep sternal wound infections. We therefore prospectively examined the en bloc resected sternal specimens. Seven standard histological sections were made from the two hemisternums. Results Forty-seven sternums could be investigated. The average age of the patients in the cohort was 67 (45–81) years and there were 10 females and 37 males. Two methods were developed to examine the histological findings, with one model examining dividing the results in inflammatory and non-inflammatory, while the second method using a score from 0 to 5 to describe more precisely the intensity of the bone inflammation. The results showed the presence of inflammation in 76.6–93.6% of the specimens, depending on the section. The left manubrial sections were more prone to inflammation, especially when the left mammary artery was harvested (LIMA). No further risk factors proved to have a statistical significance. Conclusion Our study proved that the deep sternal wound infection may cause a ubiquitous inflammation of the sternal bone, which justifies the complete sternectomy. The harvest of the left mammary artery may worsen the extent and intensity of infection.