Disruption and infection of median sternotomy: a comprehensive review

Disruption and infection of median sternotomy wounds are grave complications often associated with prolonged hospitalization, high cost, and significant mortality. Effective prevention techniques are still debated. Successful management requires early recognition based on a high index of suspicion,...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2002-05, Vol.21 (5), p.831-839
Main Authors: Losanoff, Julian E., Richman, Bruce W., Jones, James W.
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Disruption
Humans
Infection
Median sternotomy
Mediastinitis
Mediastinitis - surgery
Medical sciences
Microbiology
Risk Factors
Sternum - surgery
Surgery
Surgical Wound Dehiscence - diagnosis
Surgical Wound Dehiscence - therapy
Surgical Wound Infection - diagnosis
Surgical Wound Infection - drug therapy
Surgical Wound Infection - prevention & control
Suture Techniques
Techniques
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Summary:Disruption and infection of median sternotomy wounds are grave complications often associated with prolonged hospitalization, high cost, and significant mortality. Effective prevention techniques are still debated. Successful management requires early recognition based on a high index of suspicion, detailed physical examination, appreciation of the clinical signs and symptoms, timely imaging studies, and prompt surgical therapy. Improvements in perioperative management and critical care of patients with multisystem organ failure can reduce morbidity and mortality rates. Sternal salvage and direct sternal reclosure are possible when the infection is diagnosed early. Techniques utilizing lateral sternal support should be first-line options in the condition. Muscle flap techniques should be the next consideration when direct closure has failed or cannot be attempted.
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(02)00124-0