Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience
Background: Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flap...
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| Veröffentlicht in: | Surgical infections 2023-03, Vol.24 (2), p.131-140 |
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| container_title | Surgical infections |
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| creator | Blake, Alexandra Condrey, Megan Hansen, Leslie Mehan, Vineet |
| description | Background:
Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections.
Patients and Methods:
This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated.
Results:
Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p |
| doi_str_mv | 10.1089/sur.2022.246 |
| format | Article |
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Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections.
Patients and Methods:
This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated.
Results:
Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p < 0.0001) as experience and frequency of plate fixation increased (p < 0.0001). Regardless of infection status, all but one patient had a healed and stable sternum at the end of data collection.
Conclusions:
There is no statistically significant difference between wound class prior to SRPF and development of infection after SRPF. Even in infected settings, patients can be treated successfully with SRPF. Further study is needed.</description><identifier>ISSN: 1096-2964</identifier><identifier>EISSN: 1557-8674</identifier><identifier>DOI: 10.1089/sur.2022.246</identifier><identifier>PMID: 36735615</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc., publishers</publisher><subject>Fracture Fixation, Internal - adverse effects ; Humans ; Retrospective Studies ; Sternotomy - adverse effects ; Sternum - surgery ; Surgical Infection Society Articles ; Surgical Wound Infection - etiology</subject><ispartof>Surgical infections, 2023-03, Vol.24 (2), p.131-140</ispartof><rights>2023, Mary Ann Liebert, Inc., publishers</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c291t-c3b2a113f2ed53c3189a810e66ee623a25afd05ff405fd1ffc27e91b1ce16d6e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36735615$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blake, Alexandra</creatorcontrib><creatorcontrib>Condrey, Megan</creatorcontrib><creatorcontrib>Hansen, Leslie</creatorcontrib><creatorcontrib>Mehan, Vineet</creatorcontrib><title>Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience</title><title>Surgical infections</title><addtitle>Surg Infect (Larchmt)</addtitle><description>Background:
Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections.
Patients and Methods:
This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated.
Results:
Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p < 0.0001) as experience and frequency of plate fixation increased (p < 0.0001). Regardless of infection status, all but one patient had a healed and stable sternum at the end of data collection.
Conclusions:
There is no statistically significant difference between wound class prior to SRPF and development of infection after SRPF. Even in infected settings, patients can be treated successfully with SRPF. Further study is needed.</description><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Sternotomy - adverse effects</subject><subject>Sternum - surgery</subject><subject>Surgical Infection Society Articles</subject><subject>Surgical Wound Infection - etiology</subject><issn>1096-2964</issn><issn>1557-8674</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0E4qOwMSOPDE3x2Y3TsKGKQiW-REGMkeucIShxiu2I8u9xVGBkuTu99-gdHkKOgY2ATfIz37kRZ5yP-FhukX1I0yyZyGy8HW-Wy4TncrxHDrx_ZwwyLuUu2RMyE6mEdJ983SqrXrFBG2hr6CKgs6qmL21nSz-kc2tQh6q18Va2_PvftTZ5tjGnn1V4ow-1Ckhn1Vr17Dl9RN_VgRrXNlTRRWVfa4wrMpfrFboKrcZDsmNU7fHoZw_I8-zyaXqd3NxfzacXN4nmOYREiyVXAMJwLFOhBUxyNQGGUiJKLhRPlSlZasw4jhKM0TzDHJagEWQpUQzI6aZ35dqPDn0omsprrGtlse18wbNMAMiUs4gON6h2rfcOTbFyVaPcVwGs6GUXUXbRyy6i7Iif_DR3ywbLP_jXbgT4BuhjZW1d4RJd-L_1G6PrjMs</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Blake, Alexandra</creator><creator>Condrey, Megan</creator><creator>Hansen, Leslie</creator><creator>Mehan, Vineet</creator><general>Mary Ann Liebert, Inc., publishers</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230301</creationdate><title>Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience</title><author>Blake, Alexandra ; Condrey, Megan ; Hansen, Leslie ; Mehan, Vineet</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c291t-c3b2a113f2ed53c3189a810e66ee623a25afd05ff405fd1ffc27e91b1ce16d6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Sternotomy - adverse effects</topic><topic>Sternum - surgery</topic><topic>Surgical Infection Society Articles</topic><topic>Surgical Wound Infection - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blake, Alexandra</creatorcontrib><creatorcontrib>Condrey, Megan</creatorcontrib><creatorcontrib>Hansen, Leslie</creatorcontrib><creatorcontrib>Mehan, Vineet</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical infections</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blake, Alexandra</au><au>Condrey, Megan</au><au>Hansen, Leslie</au><au>Mehan, Vineet</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience</atitle><jtitle>Surgical infections</jtitle><addtitle>Surg Infect (Larchmt)</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>24</volume><issue>2</issue><spage>131</spage><epage>140</epage><pages>131-140</pages><issn>1096-2964</issn><eissn>1557-8674</eissn><abstract>Background:
Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections.
Patients and Methods:
This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated.
Results:
Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p < 0.0001) as experience and frequency of plate fixation increased (p < 0.0001). Regardless of infection status, all but one patient had a healed and stable sternum at the end of data collection.
Conclusions:
There is no statistically significant difference between wound class prior to SRPF and development of infection after SRPF. Even in infected settings, patients can be treated successfully with SRPF. Further study is needed.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc., publishers</pub><pmid>36735615</pmid><doi>10.1089/sur.2022.246</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1096-2964 |
| ispartof | Surgical infections, 2023-03, Vol.24 (2), p.131-140 |
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| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Fracture Fixation, Internal - adverse effects Humans Retrospective Studies Sternotomy - adverse effects Sternum - surgery Surgical Infection Society Articles Surgical Wound Infection - etiology |
| title | Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience |
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