Article

Treatment of infected sternal wounds

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Abstract

During the 10-year period between January 1962 and December 1971, 6,014 patients have undergone myocardial revascularization utilizing a median sternotomy incision. Postoperative wound dehiscence, when combined with infection of the sternum, is an uncommon, but serious complication.

The conventional method of treating infected wounds by widely opening and packing the wound cannot be applied to the sternum because the heart or both pleural cavities are exposed, and the sternum must be closed to prevent respiratory difficulty.

Our purpose is to report our experience in treatment of infection and dehiscence of the sternum by continuous irrigation with an antibiotic solution, with primary closure of the sternum, and delayed closure of the skin.

Clinical material

Infection of the median sternotomy incision developed in three patients who had undergone myocardial revascularization. In all three patients a standard median sternotomy incision was made and the sternum was divided by an electric oscillating saw (Sarns). Bleeding from the periosteum and bone marrow was controlled by electrocautery and bone wax. The sternum was approximated by six or seven wire sutures (Fig. 1). The subcutaneous tissue was closed with 2-0 catgut and the skin was closed with silk sutures. Antibiotics were given during the operation and continued for 7 days.

Case reports

Case 1. A 60-year-old man had saphenous vein grafts to the circumflex and anterior descending arteries, and a left internal mammary artery implant on December 12, 1970. Severe bilateral diffuse pulmonary infiltration developed on the 1st postoperative day and a tracheostomy was performed the 2nd . . .


 

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