The outcome of sternum healing among diabetic patients undergoing open heart surgery: a literature review

Abstract

Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach. Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy. Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it. Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.