Clinical Outcomes of the Treatment of Sternal Dehiscence after Cardiac Surgery_West China Medical Journal

Authors：

 ZhuPeng , YouHao , LiuFei , YangQian

Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen, Fujian 361004, P. R. China;

Corresponding author：

Keywords：

Cardiac surgical procedure; Sternal dehiscence; Debridement

DOI：

10.7507/1002-0179.201600232

Video：

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Objective To summarize the experiences of surgical treatment of sternal dehiscence after cardiac surgery. Methods From January 2011 to January 2014, 7 patients with sternal dehiscence after cardiac surgery were admitted to our hospital. There were 4 male patients and 3 females with an age of 35-72 (52.5±13.4) years old. Two patients accepted coronary artery bypass, 4 underwent mechanical valve replacement and 1 underwent Sun’s procedure. The necrotic bones were debrided and sternal wires completely removed. After the original wires were completely extracted, the infected tissues behind the sternum were removed. Part of the pectoralis major was released with free tension on both sides when suturing was carried out over the sternal defect. Negative pressure drainage tube was used for full drainage. Results All the patients were discharged from hospital with very good recovery. The sternal wound was healing well with normal thoracic appearance, and none of the patients had recurrent infections. Conclusions Patients with sternal dehiscence after cardiac surgical procedure should undergo surgical debridement. Stabilizing the sternum, rich blood supply and improvement of overall condition of the patients are very important for recovery.

Citation： ZhuPeng, YouHao, LiuFei, YangQian. Clinical Outcomes of the Treatment of Sternal Dehiscence after Cardiac Surgery. West China Medical Journal, 2016, 31(5): 850-853. doi: 10.7507/1002-0179.201600232 Copy

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2.	Motomatsu Y, Imasaka K, Tayama E, et al. Midterm results of sternal band closure in open heart surgery and risk analysis of sternal band removal[J]. Artif Organs, 2016, 40(2) : 153-158.
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6.	Losanoff JE, Collier AD, Wagner-Mann CC, et al. Biomechanical comparison of median sternotomy closures[J]. Ann Thorac Surg, 2004, 77(1) : 203-209.
7.	Anger J, Dantas DC, Arnoni RT, et al. A new classification of poststernotomy dehiscence[J]. Rev Bras Cir Cardiovasc, 2015, 30(1) : 114-118.
8.	El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management[J]. Ann Thorac Surg, 1996, 61(3) : 1030-1036.
9.	Casha AR, Manche A, Gatt R, et al. Mechanism of sternotomy dehiscence[J]. Interact Cardiovasc Thorac Surg, 2014, 19(4) : 17-621.
10.	Bejko J, Bottio T, Tarzia V, et al. Nitinol flexigrip sternal closure system and standard sternal steel wiring: insight from a matched comparative analysis[J]. J Cardiovasc Med (Hagerstown), 2015, 16(2) : 134-138.
11.	Park KU, Moquin K. Novel use of external tissue expander for management of sternal wound dehiscence[J]. Ann Thorac Surg, 2015, 100(4) : e81-e83.
12.	Schimmer C, Sommer SP, Bensch M, et al. Sternal closure techniques and postoperative sternal wound complications in elderly patients[J]. Eur J Cardiothorac Surg, 2008, 34(1) : 132-138.
13.	Subramaniam T, Keita L, Veerasingam D. Sternal talon, a novel repair for sternal dehiscence[J]. Kardiochir Torakochirurgia Pol, 2015, 12(2) : 153-154.
14.	Raman J, Straus D, Song DH. Rigid plate fixation of the sternum[J]. Ann Thorac Surg, 2007, 84(3) : 1056-1058.
15.	Wilson RM, Ghareeb PA, McClellan WT, et al. Biomechanical analysis of the FlatWire Figure 8 sternal fixation device[J]. Plast Surg (Oakv), 2014, 22(3) : 188-190.
16.	Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention[J]. Ann Thorac Surg, 2004, 78(3) : 912-917.
17.	De Palma A, Sollitto F, Loizzi D, et al. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system[J]. J Thorac Dis, 2016, 8(3) : 490-498.
18.	安君, 王巍, 樊纪丹, 等. 心脏大血管手术后胸骨感染的外科治疗[J]. 中国胸心血管外科临床杂志, 2011, 18(5) : 476-477.
19.	Chiang IH, Chen SG, Wang CH. Treatment of sternal wound infection using a free myocutaneous flap[J]. Ann Thorac Surg, 2015, 100(5) : 1907-1910.
20.	Grabert S, Erlebach M, Will A, et al. Unexpected results after sternal reconstruction with plates, cables and cannulated screws[J]. Interact Cardiovasc Thorac Surg, 2016, 22(5) : 663-667.

1. Saso S, James D, Vecht JA, et al. Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection[J]. Ann Thorac Surg, 2010, 89(2) : 661-670.
2. Motomatsu Y, Imasaka K, Tayama E, et al. Midterm results of sternal band closure in open heart surgery and risk analysis of sternal band removal[J]. Artif Organs, 2016, 40(2) : 153-158.
3. Kalab M, Karkoska J, Kaminek M,et al. Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method[J]. Interact Cardiovasc Thorac Surg, 2016, 22(3) : 305-313.
4. Fu RH, Weinstein AL, Chang MM, et al. Risk factors of infected sternal wounds versus sterile wound dehiscence[J]. J Surg Res, 2016, 200(1) : 400-407.
5. Lewandowicz E, Iljin A, Kasielska-Trojan A, et al. Selected methods of the chest wall reconstruction for sternal dehiscence after median sternotomy[J]. Pol Przegl Chir, 2014, 86(5) : 230-234.
6. Losanoff JE, Collier AD, Wagner-Mann CC, et al. Biomechanical comparison of median sternotomy closures[J]. Ann Thorac Surg, 2004, 77(1) : 203-209.
7. Anger J, Dantas DC, Arnoni RT, et al. A new classification of poststernotomy dehiscence[J]. Rev Bras Cir Cardiovasc, 2015, 30(1) : 114-118.
8. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management[J]. Ann Thorac Surg, 1996, 61(3) : 1030-1036.
9. Casha AR, Manche A, Gatt R, et al. Mechanism of sternotomy dehiscence[J]. Interact Cardiovasc Thorac Surg, 2014, 19(4) : 17-621.
10. Bejko J, Bottio T, Tarzia V, et al. Nitinol flexigrip sternal closure system and standard sternal steel wiring: insight from a matched comparative analysis[J]. J Cardiovasc Med (Hagerstown), 2015, 16(2) : 134-138.
11. Park KU, Moquin K. Novel use of external tissue expander for management of sternal wound dehiscence[J]. Ann Thorac Surg, 2015, 100(4) : e81-e83.
12. Schimmer C, Sommer SP, Bensch M, et al. Sternal closure techniques and postoperative sternal wound complications in elderly patients[J]. Eur J Cardiothorac Surg, 2008, 34(1) : 132-138.
13. Subramaniam T, Keita L, Veerasingam D. Sternal talon, a novel repair for sternal dehiscence[J]. Kardiochir Torakochirurgia Pol, 2015, 12(2) : 153-154.
14. Raman J, Straus D, Song DH. Rigid plate fixation of the sternum[J]. Ann Thorac Surg, 2007, 84(3) : 1056-1058.
15. Wilson RM, Ghareeb PA, McClellan WT, et al. Biomechanical analysis of the FlatWire Figure 8 sternal fixation device[J]. Plast Surg (Oakv), 2014, 22(3) : 188-190.
16. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention[J]. Ann Thorac Surg, 2004, 78(3) : 912-917.
17. De Palma A, Sollitto F, Loizzi D, et al. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system[J]. J Thorac Dis, 2016, 8(3) : 490-498.
18. 安君, 王巍, 樊纪丹, 等. 心脏大血管手术后胸骨感染的外科治疗[J]. 中国胸心血管外科临床杂志, 2011, 18(5) : 476-477.
19. Chiang IH, Chen SG, Wang CH. Treatment of sternal wound infection using a free myocutaneous flap[J]. Ann Thorac Surg, 2015, 100(5) : 1907-1910.
20. Grabert S, Erlebach M, Will A, et al. Unexpected results after sternal reconstruction with plates, cables and cannulated screws[J]. Interact Cardiovasc Thorac Surg, 2016, 22(5) : 663-667.

West China Medical Journal

Clinical Outcomes of the Treatment of Sternal Dehiscence after Cardiac Surgery

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