Management of Sternal Infections and Sternal Disruptions after Sternotomy with Plate Fixation

Author(s):
Alexandra Blake; Megan Condrey; Vineet Mehan

Background:

Sternal disruption and deep sternal infections after cardiac surgery remain with higher mortality rates than those without sternal complications after cardiac surgery. The reconstructive approaches on these patients have largely centered on soft tissue reconstruction by a variety of methods that result in functional loss, such as using pectoralis major or rectus abdominus muscles, to obliterate the soft tissue defect. Omental flaps have also been employed but usually necessitate a hernia. Sternal reduction and rigid fixation with transverse plates is debated in the setting of infection. Some data shows early positive advantages. The distinct advantage to reduction and fixation is use of pedicled pectoralis flaps without turnover flaps or use of abdominal flaps, as well as maintenance of sternal rigidity and upper girdle function and strength. The goal of this study was to examine the outcomes of rigid plate fixation (RPF), and to determine what factors lead to better patient outcomes

Hypothesis:

We hypothesized that despite infections most patients could be treated with RPF.

Methods:

This is a retrospective study of patients who underwent sternal reconstruction by a single plastic surgeon from April 2013 to March 2021. We evaluated the demographic and perioperative factors that were associated with recurrent sternal infection after RPF. Inclusion criteria- sternal reconstruction with RPF. Exclusion criteria- death within six months of reconstruction, addition and removal of plates multiple times.

Results:

Of the 101 patients who underwent sternal reconstruction during the timeframe, 91 met the criteria. 10/63 (16%) patients who had either clean-contaminated or infected wounds developed recurrent infection, while 4/28 (14%) patients who had clean wounds developed infection after plating (p>0.05). Of the 63 clean-contaminated/infected patients, 7/23 (30%) with high creatinine levels versus 3/40 (8%) with normal levels, and 6/18 (33%) females versus 4/45 (9%) males had recurrent infection (p=0.029, p=0.026 respectively). Over time, there was a significant increase in the number of platings performed, while the number of infections did not differ yearly (p=0.002 vs p=0.783).

Conclusions:

Overall, there is no statistically significant difference between patients with clean-contaminated/infected wounds and those with clean wounds and development of infection after RPF. Other than creatinine level and sex, all other demographic and perioperative factors were insignificant for recurrent infection.