Stelly Meghan M, Rodning Charles B, Stelly Terry C
Clemson University, Clemson, South Carolina, USA.
Department of Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA.
J Cardiothorac Surg. 2015 Nov 14;10:166. doi: 10.1186/s13019-015-0378-7.
Deep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.
In this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.
Between July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m(2) wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).
The peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.
深部胸骨伤口感染是正中胸骨切开术后一种罕见但严重的并发症。我们评估了两种胸骨闭合技术相关的深部胸骨伤口感染发生率。
在这个回顾性病例系列中，我们记录了连续接受各种心胸外科手术患者的胸骨闭合方法。历史对照组的胸骨闭合采用经胸骨不锈钢丝缝合；随后的患者采用钢丝缝合结合一种新型的胸骨周围束带闭合系统来加固胸骨体。两组间围手术期护理标准化。分析了人口统计学、危险因素和术后结果。
2010年7月至2014年7月，阿拉巴马州莫比尔市一家医院的609例连续成年患者在开放式正中胸骨切开术后进行了胸骨闭合。前309例患者采用钢丝缝合完成胸骨闭合，随后的300例患者采用束带加固。除束带组术前合并症更多外，两组的基线特征具有可比性。两组间平均体重指数相当（钢丝缝合组为30.2±6.6kg/m²，束带组为30.5±7.7，p = 0.568）。钢丝缝合组2.6%（8/309）的患者发生了深部胸骨伤口感染，而束带组未观察到深部胸骨伤口感染（p = 0.008）。
胸骨周围束带系统是开放式正中胸骨切开术后胸骨闭合的一种简单可靠的方法，即使在肥胖和合并症患者中，也与深部胸骨伤口感染风险降低相关。
