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The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 861-867, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
C Serry, PC Bleck, H Javid, JA Hunter, MD Goldin, GA DeLaria and H Najafi
Of 4,124 patients undergoing median sternotomy for cardiac operations, 1.8%
had sternal wound complications. These included wound drainage, skin
separation, unstable sternum, and sternal dehiscence with or without
infection. Septicemia and mediastinal abscess were found in all 19 patients
who died. Incision and drainage of skin and subcutaneous tissue with
frequent changes of dressing or irrigation (Method A) is recommended for
those patients with (I) serosanguineous drainage only or (2) a stable
sternum and superficial infection without systemic reaction. Surgical
debridement of the sternum and mediastinum with reclosure followed by
mediastinal irrigation via drainage tubes with 0.5% povidone-iodine
solution (Method B) is recommended for patients with (1) a draining,
unstable sternum, (2) infection involving the retrosternal space, or (3)
infection causing a systemic reaction unresponsive to Method A. None of the
eight patients in the latter group with more serious infections died when
managed by Method B, and only one had recurrent infection. In contrast, of
28 patients of the latter group not treated with Method B, 11 died of
infection-related causes and 13 returned with recurrent infection.
ARTICLES
Sternal wound complications. Management and results
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