Subject(s)
Autoimmune Diseases/immunology , Immunoglobulin G/immunology , Salivary Gland Diseases/immunology , Tuberculosis, Pulmonary/immunology , Adrenal Cortex Hormones/therapeutic use , Aged , Antitubercular Agents/therapeutic use , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/drug therapy , Biopsy, Needle , Follow-Up Studies , Humans , Immunohistochemistry , Male , Mycobacterium tuberculosis/isolation & purification , Rare Diseases , Salivary Gland Diseases/complications , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/therapy , Thoracic Surgery, Video-Assisted/methods , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/therapyABSTRACT
BACKGROUND: Postcardiotomy sternal wound complications remain challenging. The prevailing approach for deep sternal wound infection of debridement and flap coverage without osseous closure makes subsequent reoperation difficult. METHODS: An analysis of all patients undergoing cardiac surgery at a single institution between 1986 and 2001 was conducted. Prospective data collection and chart review were used to compare different treatment strategies for sternal complications. RESULTS: Of 5337 patients, 122 had sternal wound complications (2.2%) comprising 15 (0.3%) uninfected dehiscences (El Oakley class 1), 45 (0.8%) superficial infections (El Oakley class 2A), and 62 (1.1%) deep sternal wound infections (El Oakley class 2B). Thirty-two patients with deep sternal infection were treated by debridement, rewiring, and delayed primary closure. There were initial treatment failures in 6 patients (18.8%) and ultimate failures in 2 patients (6.3%), both of whom died. One of these patients had previously received external beam radiation after a radical mastectomy for breast cancer. Median length of stay was 32 days and median time to wound healing was 85 days. Twenty-five patients were managed by muscle flap coverage without sternal reclosure. There were 6 initial treatment failures (24%) but no ultimate failures or deaths (p = NS). Median length of stay was 31 days and median infection time was 161 days. CONCLUSIONS: In patients with postcardiotomy deep sternal wound infection without previous chest radiation, debridement, rewiring, and delayed skin closure is effective. It offers a shorter healing time and probably makes late cardiac reoperation safer. We propose an algorithm for the management of poststernotomy complications.
