Sternotomy infections: Sternal salvage and the importance of sternal stability

OBJECTIVE: To review the management of sternal wound infections after cardiovascular surgery. DESIGN: Retrospective case study. SETTING: All management took place in a single tertiary-care university hospital. PATIENTS: Twenty-one consecutive patients seen over a 3-year period who had infected median sternotomy incisions after cardiovascular surgery. INTERVENTIONS: Surgical eradication of infection, including sternal debridement and rewiring or placement of vascularized muscle flaps, or both. MAIN OUTCOME MEASURES: Resolution of infection and restoration of sternal stability. RESULTS: The development of sternal wound infection was found to be associated with sternal instability. In 12 of 17 patients treated initially with sternal debridement and rewiring the infection was cured. Vascularized muscle nap transfers were required to eradicate the infection in the remaining patients. CONCLUSIONS: Sternal debridement and rewiring is an effective initial treatment for sternal wound infections in selected patients. Some patients may require placement of muscle naps for definitive treatment.