The Analysis Of The Risk Factors And Treatment Of The Deep Sternal Wound Infection After Cardiac Surgery

ObjectiveThe deep sternal wound infection (DSWI) was a serious complication after cardiac surgery, which not only substantially influence the patient’s quality of life and survival rate, but also prolonged length of stay and increased the hospitalization costs. The cardiac surgical operation cases of our hospital in recent years were retrospectively analysed to try to find the risk factors of the deep sternal wound infections.MethodsBetween January 2003 and December 2013, a total of 2756 cardiac procedures with median sternotomy were performed in the General Hospital of Beijing Military Region. Patients were divided in two groups:deep sternal wound infection developed in 53patients (1.92%) (DSWI group),, the other 2703 cases had no deep sternal wound infection (control group). The perioperative data were compared between two groups. Logistic regression analysis was used to identify independent risk factors associated with post-operative deep sternal wound infection.ResultsThe results of the logistic regression analysis showed that the independent predictors of deep sternal wound infection were obesity, New York Heart Association class> 3, diabetes,LVEF<30%, emergency cardiac operation, operation time> 4h, mechanical ventilation time>24h, length of ICU stay> 48h, re-exploration for bleeding. Multivariate analysis showed that NYHA> 3 level (OR 1.6; P< 0.05), LVEF<30% (OR 1.9; P< 0.05), emergency cardiac operation (OR 1.6; P< 0.05), reoperation (OR 4.4; P< 0.05), mechanical ventilation time>24h (OR 1.6; P< 0.05) were all high risk factors of the deep sternal wound infection after cardiac surgery.ConclusionsNYHA>grade 3, LVEF<30%, emergency cardiac operation, mechanical ventilation time>24h, and reoperation are high risk factors of the deep sternal wound infection after cardiac surgery,ObjectiveThe deep sternal wound infection is a serious complication after cardiac surgery.The therapies was mainly including open dressing operation, closed irrigation, vacuum assisted closure, sternal rewire, rectus abdominis muscle flap transposition, omental flap transposition, pectoralis major muscle flap transposition,.They have advantages and disadvantages. The aim of this study was to explore the feasibility and clinical outcome of modified pectoralis major muscle flap transposition for the deep sternal wound infection.MethodsThe one hundred and nine patients with deep sternal wound infection after cardiac surgery were divided into two groups in the General Hospital of Beijing Military Region from January 2003 to December 2014.The group A had 53 cases who recieved the treatment of the opening drainage and debridement dressing; The group B had 56 cases who recieved the modified pectoralis major muscle flap transposition. In group B, the procedure were performed by general anesthesia; infection and necrotic tissues were thoroughly removed; modified pedicled pectoralis major muscle flaps were manufactured, the residual cavity was filled with the modified pedicled pectoralis major muscle flaps; muscle flaps were properly fixed; skin and subcutaneous tissues were sutured,;drainage tubes with negative pressure were retained;chest straps were used after surgery. Time of postoperative hospitalization, costs of hospitalization, time of using antibiotics, the rate of recovery, rate of recurrence and mortality were compared and analysed between the two groups.ResultsMean hospital stay was significantly higher in Group A(100.18±82.00 days) versus Group B (27.63±13.68 days); The costs in group A (10,1406±4,5828 yuan) was significantly higher than group B (4,0825±3,1689 yuan)(P<0.05); Time of using antibiotics of group A was 20.04±9.67 days, group B was 8.79± 3.32 days, the time of using antibiotics between two groups was significantly differerent; The covery rate of group A was 75.47% and group B was 87.50%, the two groups have statistical difference (P<0.05); The rate of recurrence in group A was higher than group B {(8.93% vs20.75%) (P<0.05)}; The mortality of group A was 3.77%, while group B was 3.57%, the difference between two groups was no statistically significance.ConclusionModified pectoralis major muscle flap transposition seems to be safe,effective and feasible for the treatmentof the deep sternal wound infection.