Early Repair of Sternal Instability Prevents Mediastinitis


Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

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Aykut, K. , Albayrak, G. , Kavala, A. , Guzeloglu, M. , Karaarslan, K. and Hazan, E. (2014) Early Repair of Sternal Instability Prevents Mediastinitis. World Journal of Cardiovascular Surgery, 4, 13-16. doi: 10.4236/wjcs.2014.42003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Diez, D. Koch, O. Kuss, R. E. Silber, I. Freidrich and J. Boergermann, “Risk Factors for Mediastinitis after Cardiac Surgery—A Retrospective Analysis of 1700 Patients,” Journal of Cardiothoracic Surgery, Vol. 20, No. 2, 2007, p. 23. http://dx.doi.org/10.1186/1749-8090-2-23
[2] C. S. Hollenbeak, D. M. Murphy, S. Koenig, R. S. Woodward, W. C. Dunagan and V. J. Fraser, “The Clinical and Economic Impact of Deep Chest Surgical Site Infections Following Coronary Artery Bypass Graft Surgery,” Chest, Vol. 118, No. 2, 2000, pp. 397-402. http://dx.doi.org/10.1378/chest.118.2.397
[3] K. Aykut, B. Celik and U. Acikel, “Figure-of-Eight versus Prophylactic Sternal Weave Closure of Median Sternotomy in Diabetic Obese Patients Undergoing Coronary Artery Bypass Grafting,” Annals of Thoracic Surgery, Vol. 92, No. 2, 2011, pp. 638-641. http://dx.doi.org/10.1016/j.athoracsur.2011.04.034
[4] F. Ceresa, G. Casablanca and F. Patanè, “Complicated Sternal Dehiscence Treated with the Strasbourg Thoracic Osteosyntheses System (STRATOS) and the Transposition of Greater Omentum: A Case Report,” Journal of Cardiothoracic Surgery, Vol. 5, 2010, p. 53. http://dx.doi.org/10.1186/1749-8090-5-53
[5] M. L. Dalton, S. R. Connally and W. C. Sealy, “Julian’s Reintroduction of Milton’s Operation,” Annals of Thoracic Surgery, Vol. 53, No. 3, 1992, pp. 532-533. http://dx.doi.org/10.1016/0003-4975(92)90293-D
[6] A. R. Casha, L. Yang, P. H. Kay, M. Saleh and G. J. Cooper, “A Biomechanical Study of Median Sternotomy Closure Techniques,” European Journal Cardio-Thoracic Surgery, Vol. 15, No. 3, 1999, pp. 365-369. http://dx.doi.org/10.1016/S1010-7940(99)00014-7
[7] The Parisian Mediastinitis Study Group, “Risk Factors for Deep Sternal Wound Infection after Sternotomy: A Prospective Multicenter Study,” Journal of Thoracic and Cardiovascular Surgery, Vol. 111, No. 6, 1996, pp. 1200-1207. http://dx.doi.org/10.1016/S0022-5223(96)70222-2
[8] H. B. Shumacker Jr. and I. Mandelbaum, “Continuous Antibiotic Irrigation in the Treatment of Infection,” Archives of Surgery, Vol. 86, No. 3, 1963, pp. 384-387.
[9] R. J. Vos, A. Yilmaz, U. Sonker, J. C. Kelder and G. T. Kloppenburg, “Vacuum-Assisted Closure of Post-Sternotomy Mediastinitis as Compared to Open Packing,” Interactive CardioVascular and Thoracic Surgery, Vol. 14, No. 1, 2012, pp. 17-21. http://dx.doi.org/10.1093/icvts/ivr049
[10] J. Sjogren, J. Nilsson, R. Gustafsson, M. Malmsjo and R. Ingemansson, “The Impact of Vacuum-Assisted Closure on Long-Term Survival after Post-Sternotomy Mediastinitis,” Annals of Thoracic Surgery, Vol. 80, No. 4, 2005, pp. 1270-1275. http://dx.doi.org/10.1016/j.athoracsur.2005.04.010

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