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An alternative inexpensive treatment for deep sternal wound infections after sternotomy

Hyperbaric Center, ICOT, V. F. Faggiana 34, Latina, Italy

^* Corresponding author. ‘M.G. Vannini‘ Hospital, V. Acqua Bullicante no. 4, I-00177 Rome, Italy. Tel.: +39-62-429-1340; fax: +39-62-430-3834
a.lappa{at}libero.it

We present three cases of deep sternal wound infections after sternotomy, with partial dehiscence and instability of sternum, successfully treated with combined therapy based on hyperbaric oxygen (HBO), parenteral and intranasal antibiotics, daily debridements and medications. After a short hospitalization (10 days) to detect involved bacteria, depth of the wounds and choice of right antibiotic therapy, all patients continued the treatment as outpatients, undergoing daily medications and antibiotic therapy before every HBO session. After 3 months the sternal wounds were completely epithelialized. This conservative therapy for deep sternal wound infections can be an alternative and inexpensive approach to surgical treatment. The aggressive surgical approach could be limited for those deep sternal wounds associated with broad dehiscence and instability of sternum, complicated by paradoxical breathing and/or mediastinitis and alteration of respiratory system mechanics.

Key Words: Deep sternal wound infection; Mupirocin; Nasal carriage; Post antibiotic effect; Post antibiotic enhancement; Hyperbaric oxygen

Abbreviations: HBO, hyperbaric oxygen • MPN, mupirocin • S., aureus, Staphylococcus aureus • VAC, vacuum assisted closure • PAE, post antibiotic effect • PALE, post antibiotic leukocyte enhancement • CABG, coronary artery bypass graft • IMA, internal mammary artery