Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection

S. F. Lovich, L. I G Iverson, J Nilas Young, C. L. Ennix, J. E. Harrell, R. R. Ecker, G. Lau, P. Joseph, I. A. May

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Postcardiotomy sternal infection occurred in 20 (2%) of 1007 patients undergoing cardiac surgery between September 1985 and December 1987, a 10-fold increase over the preceding 33 months (4 [0.24%] of 1627 patients). Cultures were sterile in 5 patients and yielded staphylococci in 12 and a variety of bowel organisms in 3. The cause for the increased occurrence of sternal wound infection is unclear after multivariate analysis, although infections have precipitously dropped subsequent to changing to cefuroxime sodium antibiotic prophylaxis. Treatment has evolved to appropriate antibiotics and early debridement of involved sternum and cartilage. Rewiring the sternum is not attempted. If gross purulence is not present, primary closure is accomplished using muscle flaps (2 patients) or omental pedicle grafts (17 patients). In the presence of gross purulence, the wound is packed open for 5 days and then closed in the above fashion. Two patients required skin grafts for primary closure. The omental pedicle flap is preferred due to simplicity and improved coverage of the sternal defect inferiorly. Nineteen patients healed primarily. A superficial wound infection was drained in 1 patient. Midline incisional hernia developed in 3 muscular patients. Omentum is now harvested through a left subcostal incision. Hospital stay was under 2 weeks in 13 patients. One death occurred due to multisystem failure prior to completion of wound closure. In our experience, early sternal debridement and omental pedicle grafting with primary closure is appropriate therapy for psotcardiotomy sternotomy infections. The presence of gross purulence may require 5 days of open packing prior to omental grafting. No significant complications occurred, and mortality was low. A left subcostal incision for omental harvesting is utilized to avoid the occurrence of delayed incisional hernias.

Original languageEnglish (US)
Pages (from-to)1192-1194
Number of pages3
JournalArchives of Surgery
Volume124
Issue number10
StatePublished - 1989
Externally publishedYes

Fingerprint

Sternotomy
Infection
Therapeutics
Sternum
Debridement
Wound Infection
Transplants
Cefuroxime
Omentum
Antibiotic Prophylaxis
Wounds and Injuries
Staphylococcus
Thoracic Surgery
Cartilage
Length of Stay
Multivariate Analysis
Sodium
Anti-Bacterial Agents
Muscles
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Lovich, S. F., Iverson, L. I. G., Young, J. N., Ennix, C. L., Harrell, J. E., Ecker, R. R., ... May, I. A. (1989). Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection. Archives of Surgery, 124(10), 1192-1194.

Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection. / Lovich, S. F.; Iverson, L. I G; Young, J Nilas; Ennix, C. L.; Harrell, J. E.; Ecker, R. R.; Lau, G.; Joseph, P.; May, I. A.

In: Archives of Surgery, Vol. 124, No. 10, 1989, p. 1192-1194.

Research output: Contribution to journalArticle

Lovich, SF, Iverson, LIG, Young, JN, Ennix, CL, Harrell, JE, Ecker, RR, Lau, G, Joseph, P & May, IA 1989, 'Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection', Archives of Surgery, vol. 124, no. 10, pp. 1192-1194.
Lovich SF, Iverson LIG, Young JN, Ennix CL, Harrell JE, Ecker RR et al. Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection. Archives of Surgery. 1989;124(10):1192-1194.
Lovich, S. F. ; Iverson, L. I G ; Young, J Nilas ; Ennix, C. L. ; Harrell, J. E. ; Ecker, R. R. ; Lau, G. ; Joseph, P. ; May, I. A. / Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection. In: Archives of Surgery. 1989 ; Vol. 124, No. 10. pp. 1192-1194.
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