Chronic Sternal Wound Fistula after Coronary Artery Bypass Surgery: A Case Series

Chronic extensive infection of the sternal wound may be a serious problem in patients undergoing sternotomy, especially those who have been operated for coronary artery bypass grafts. We report and evaluate the outcomes of five cases involved in chronic sternal osteomyelitis who were treated with two different strategies as follows: (1) debridement and secondary healing (conventional treatment), and (2) debridement and omental flap transfer for primary wound closure. All of the patients had acceptable results after treatment, but those who were managed by omental flap and primary wound closure had better cosmetic results and a shorter hospital stay.

[1]  M. Masala,et al.  Post-sternotomy chronic osteomyelitis: is sternal resection always necessary? , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  R. Hetzer,et al.  Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  J. Sjögren,et al.  Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  J. Nilsson,et al.  Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. , 2005, The Annals of thoracic surgery.

[5]  R. Koerfer,et al.  Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. , 2005, The Annals of thoracic surgery.

[6]  T. Kouchoukos Kirklin/Barratt-Boyes Cardiac Surgery , 2003 .

[7]  H. Luckraz,et al.  Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. , 2003, The Journal of thoracic and cardiovascular surgery.

[8]  M. Czerny,et al.  The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. , 2002, The Annals of thoracic surgery.

[9]  Á. Péterffy,et al.  Technical refinements of omentopexy and pectoralis myoplasty for poststenotomy mediastinitis. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[10]  S. Ohri,et al.  Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. , 2000, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[11]  W. D. de Boer,et al.  Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. , 1999, The Annals of thoracic surgery.

[12]  K. Kunzelman,et al.  Prospective trial of catheter irrigation and muscle flaps for sternal wound infection. , 1998, The Annals of thoracic surgery.

[13]  H. Takahashi,et al.  [Two case reports of recurrent mediastinitis with chronic mediastinal fistula successfully treated with muscle flap re-transposition]. , 1994, Kyobu geka. The Japanese journal of thoracic surgery.

[14]  P. Pairolero,et al.  Long-term results of pectoralis major muscle transposition for infected sternotomy wounds. , 1991, Annals of surgery.

[15]  J. B. Choi,et al.  Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. , 1999, The Annals of thoracic surgery.

[16]  P. Griffin Reduction mammaplasty combined with pectoralis major muscle flaps for median sternotomy wound closure. , 1996, British journal of plastic surgery.