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Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers

Universitätsklinikum Würzburg, Klinik für Herz-, und Thoraxchirurgie, Oberdürrbacherstraße 6, 97080 Würzburg, Germany

*Corresponding author. Universitätsklinikum Würzburg, Klinik und Poliklinik für Herz-, und Thoraxchirurgie, Oberdürrbacherstraße 6, 97080 Würzburg, Germany. Tel.: +49 (0) 931-2010; fax: +49 (0) 931-201 33 009.

E-mail address: Schimmerc{at}klinik.uni-wuerzburg.de (C. Schimmer).

There are various primary treatment modalities of managing deep sternal wound infection (DSWI) following cardiac surgery, namely surgical debridement with primary reclosure in conjunction with irrigation, Vacuum-assisted closure (V.A.C.^®) therapy, and primary or delayed flap closure. The purpose of this study was to assess whether there is consensus of the primary management of DSWI using one method as a single line therapy or a combination of these procedures. Therefore, a questionnaire with regards to the primary treatment modalities of DSWI was distributed to all 79 German heart surgery centers. All replied to the questionnaire. V.A.C.^® is used in 28/79 (35%) heart centers as the ‘first-line’ treatment, 22/79 (28%) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37%) clinics both treatment options were used according to intraoperative conditions. Mostly, as a primary management of DSWI two treatment modalities are mainly in use: primary reclosure coupled with a double-tube suction/irrigation system and V.A.C.^® therapy. The current understanding is based purely on retrospective studies, not evidence-based medicine. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing these treatment modalities are pivotal to define evidence for patients presenting with DSWI.

Key Words: Deep sternal wound infection; Poststernotomy mediastinitis; Vacuum-assisted closure; Primary reclosure; Suction/irrigation system