Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

Descriptive analysis of right and left-sided traumatic diaphragmatic injuries; case series from a single institution

Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury [TDI] in a single level I trauma center

Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left [LTDI] and right [RTDI]

Results: A total of 52 TDI cases [79% LTDI and 21% RTDI] were identified with a mean age of 31 +/- 11. LTDI patients were more likely to have higher Injury severity scores [p=0.50] and greater AAST organ injury scoring [p=0.661 for all] than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI [p=0.342]. Recurrent DIs was reported only in LTDI [5.1% vs. 0.0%; p=0.911]. Twelve patients died [9 LTDI and 3 RTDI], of them 5 had associated head injury

Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment