Objectives: To evaluate outcome of modalities for management of deep sternal wound infection (DSWI) defined as peri-procedural mortality and to determine the predictors for this outcome.
Patients & Methods: Management plan was controlled by the findings after sternal wound debridement till patient was bacteriologically negative and ranged between simple rewiring of sternal remnants, if appropriate, rewiring and bilateral pectoralis major advancement flap (PMF) coverage, vascularized omental flap (VOF) or PMF coverage without rewiring if sternal remnants were inappropriate and combined VOF and PMF coverage in case of wide sternal defect and/or absence of any trustable sternal remnants.
Results: Throughout the study duration 121 out of 7850 patients underwent sternotomy for open cardiac surgery developed DSWI for a frequency of 1.54%. Nineteen patients died for a total mortality rate of 15.7%, 9 patients developed complications for a morbidity rate of 7.4% and 93 patients passed their postoperative (PO) course uneventfully for a total success rate of 76.9%. PMF and VOF showed success rates of 94.7% and 81.8%, respectively. Wiring only and wiring followed by PMF showed success rates of 78.6% and 75%, respectively. Combined VOF and PMF showed a success rate of 72.2% for selected cases with wide sternal wound. Number of risk factors/patient was significantly higher in non-survivors than in survivors. Obesity and multiplicity of risk factors were the most significant predictors for mortality. Individually obesity and diabetes mellitus were the significant predictors for mortality.
Conclusion: Management of DSWI is tedious, has prolonged hospital stay and is associated with high morbidity and mortality rates. Management of DSWI must be personalized according to findings on exploration of the sternal wound and flap coverage must be initiated only when the patient is bacteriologically free. Both PMF and/or VOF provided high acceptable success rate defined as survival free of DSWI recurrence.
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