HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Johnson, J. A. Articles by Cogbill, T. H. Search for Related Content PubMed PubMed Citation Articles by Johnson, J. A. Articles by Cogbill, T. H.

The Annals of Thoracic Surgery, Vol 47, 270-273, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Delayed primary closure after sternal wound infection

JA Johnson, WE Gall, AE Gundersen and TH Cogbill
Department of Thoracic and Cardiovascular Surgery, Wisconsin Heart Institute, Gundersen/Lutheran Medical Center, La Crosse 54601.

Infected median sternotomy is a major complication of cardiac operations. Over a 30-month period, 25 sternal wound infections were treated at a single institution. Twenty-four (2.7%) followed 883 operations with cardiopulmonary bypass, and 1 followed median sternotomy for a noncardiac procedure. Twenty-one of the 25 patients survived to sternal closure. Eighteen patients were treated with delayed primary closure and 3 with pectoralis muscle flaps. Fifteen patients (83%) had an uneventful postoperative course after delayed primary closure. In 2 patients reoperation was required for sternal dehiscence, and in 1 patient a superficial wound infection developed, which was treated with local wound care. In all 18 patients the sternum eventually healed. Criteria for delayed primary closure included clean tissue surfaces without purulent debris, the absence of pockets of purulent drainage, and negative wound cultures obtained 24 hours before closure. The average time from operation to sternal incision and drainage was 11 days (range, five to 59 days). Delayed primary closure was performed nine days after incision and drainage (range, five to 27 days). The average hospital stay was 24 days after sternal incision and drainage (range, nine to 85 days). Cultures from specimens taken at the time of sternal incision and drainage were positive in all patients. Wound cultures were positive at the time of sternal closure in 5 patients. Wound complications developed in 2 of these 5 patients. Delayed primary closure has many of the advantages of classic methods, but fewer complications. Results are comparable, while allowing simpler wound care and less cosmetic deformity. Delayed primary closure is an acceptable alternative in the treatment of sternal wound infections.

This article has been cited by other articles:

				M. A. Borger, V. Rao, R. D. Weisel, J. Ivanov, G. Cohen, H. E. Scully, and T. E. David Deep Sternal Wound Infection: Risk Factors and Outcomes Ann. Thorac. Surg., April 1, 1998; 65(4): 1050 - 1056. [Abstract] [Full Text] [PDF]