Most patients with sternal wound infections following open heart surgery can be treated conservatively with surgical debridement and rewiring. Patients who may fail this approach can be predicted based on the presence of certain risk factors.
Risk factors associated with failure in surgical salvage procedures:
(1) positive wound culture
(2) positive blood culture
(3) (possibly) use of left internal mammary (thoracic) artery for coronary artery bypass
where:
• The culture isolates should be pathogenic organisms.
• Patients were being treated with antibiotics, so that failure to isolate an organism does not mean that an infection was absent (false negative culture).
• I did not see that there was a change in risk if the same organism was found simultaneously in the wound and blood cultures.
• The risk associated with use of the internal mammary arteries as listed in the immediately preceding sections involved diabetic patients.
• Failures from late complications were not included in the study.
Patients with 1 or more risk factors should have initial closure with muscle flaps rather than attempting to rewire the sternum.
To read more or access our algorithms and calculators, please log in or register.
