Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation

• Published in: European journal of cardio-thoracic surgery 2010-04, Vol.37 (4), p.888-892
• Main Authors: Gaudreau, Geneviève, Costache, Victor, Houde, Chanel, Cloutier, Daniel, Montalin, Livia, Voisine, Pierre, Baillot, Richard
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Bone Plates; Cardiac Surgical Procedures; Cardiology. Vascular system; Debridement; Deep sternal wound infection; Device Removal; Epidemiologic Methods; Female; Humans; Male; Mediastinitis; Mediastinitis - therapy; Medical sciences; Middle Aged; Negative pressure wound therapy; Pneumology; Reconstructive Surgical Procedures - methods; Recurrence; Sternal reconstruction with titanium plates; Sternum - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical Flaps; Surgical Wound Infection - etiology; Surgical Wound Infection - therapy; Titanium
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.07.043

Objective: To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. Methods: Between 2002 and 2007, 10 665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients. Results: Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p = 0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p ≪ 0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal. Conclusions: To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.