This well written and referenced study by Heilmann and colleagues [1] describes the experience of a single-centre over a period of two years, and includes 1297 patients. Of these, 2% (n = 24), developed deep incisional surgical site infection (SSI) and organ/space SSI according to a 1991, Centers for Disease Control (CDC) Guideline. A few salient points warrant highlighting.
If we accept that microbial swabs (n = 82) were taken of all suspected and confirmed superficial and deep wound complications (n = 76), the analysis of the infective agent is representative. Two points are then of interest: firstly, the finding that coagulase-negative Staphylococci (CoNS) were involved in all deep, but none of the superficial poststernotomy wound infections supports an earlier observation that CoNS is becoming more of a threat and more specific preventative measures should be developed to counter this (threat) [2]. Secondly, the microbial swabs and cultures were negative in two (8.3%) of the 24 patients who presented with clinical deep sternal wound infections. This figure is high enough to emphasize that alertness to the possibility of a deep sternal wound infection is more important than reliance on the outcome of microbial swabs alone.
Finally, 62.5% (15 of 24, not 45%, as the authors suggested) of patients with deep sternal wound infections required sternal "revision" and a slightly lower percentage (58%) were additionally managed with vacuum assisted closure (VAC) therapy. It would be of interest to know how the rest of the group of patients was managed, if not by VAC-therapy: was continuous drainage or an alternative method of open management used? Of particular interest, no mention of revascularization by means of flap surgery (muscle or omentum) was made. Unless the authors routinely advance the pectoral muscles medially, following sternal revision and wound closure, the lack of need for flap surgery could indicate that the diagnosis was made very early, when no or minimal sternal destruction had occurred and for this, the authors should be commended.
Conflict of interest: none declared.
References
- 1.Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M, Olschewski M, Beyersdorf F. Wound complications after median sternotomy: a single-centre study. Interact CardioVasc Thorac Surg 2013;16:643–8 [DOI] [PMC free article] [PubMed] [Google Scholar]
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