Analysis On Risk Factors And Preventive Measures Of Median Sternal Wound Infection

ObjectiveTo analyze risk factors contributing to median sternal wound infection.Methods7056 adult patients who accepted open-heart surgery through standard sternal incision were selected from patient pool in the Shanghai Zhongshan hospital plastic surgery from January,2008 to February,2011.ResultsA total of 73 patients presented impaired wound healing. The incidence rate was 1.03%. Primary diseases such as old myocardial infarction and chronic heart failure, obesity, various surgical procedures, length of ICU care, emergency surgery, and poor postoperative blood suger management posed as important risk factors.ConclusionsActive treatment and preventive measures reduce excessive perioperative period risk factors and prevent impaired wound healing at the incision site.PART II Analysis of Risk Factors Contributing to Median Sternal Wounds Infection after Multiple DebridementObjectiveTo analyze risk factors contributing to negative influence on median sternal wound reinfection.Methods46 adult patients (above the age of 16) underwent sternal debridement and suture from January,2008 to February,2011 in the Zhongshan plastic surgery due to impaired median sternal wounds, nonunion of sternum, or mediastinum infection. Among these patients,30 patients underwent debridement twice or more. Risk factors contributing to repeated infection were obtained via single factor analysis and multi-factor analysis on these patients.ResultsA total of 30 cases, possessing 65.22% of the overall patients, exhibited impaired wound healing of multiple median sternal wound. In addition to the risk factors in the first part, the age beyond 70, remnant foreign bodies after the first debridement, presence of sternal bone after debridement, time points of post operative drainage placement posed as significant risk factors in median sternal wound infection.ConclusionsProper control and reduction of risk factors based on our analysis can reduce the chance of postoperative complication and lower the possibility of recurrence.PART III Effects of the Sternal Stability in the Healing of Median Sternal WoundsObjectiveTo explore the feasibility of titanium plate fixation, chest wall reconstruction, and bilateral pectoralis major filling in order to improve technique of sternal debridement and reduce the recurrence of infection.Methods26 adult patients (above the age of 16) were selected from patient pool in Zhongshang hospital plastic surgery from January,2008 to February,2011. The selected patients were randomly divided into two groups named as A and B. Group A contained of patients who underwent tranditional pectoralis major flap fillings while group B contained patients of titanium plate fixation with transference of musculus pectoralis major tissues at the site of incision. Both groups were compared perioperative period.Results5 patients out of 13 patients in group A reiterated impaired wounds healing of median sternal wound. Only one patient in group B presented postoperative hemorrhage. Drainage tubes in group B were removed earlier than group A.ConclusionsApplication of titanium plate fixation and sequential proper maintenance of sternal incision demonstrate obvious improvement on healing and significant reduction of recurrent infection. In addition, application of titanium plate fixation also lowers the possibility of postoperative complications.