Prevention and treatment of deep sternal wound infection after cardiac surgery

Deep sternal wound infection is a devastating complication of cardiac surgery, with low incidence, but serious consequences in terms of morbidity and mortality. Measures to prevent deep sternal wound infection are reviewed in the first section of this thesis. We described and compared several treatment methods for deep sternal wound infection. Open packing of the wound showed to be inferior to vacuum-assisted closure when used as bridge to wound closure. Primary closure using Redon drains showed to be an effective treatment method, with a significantly reduced length of hospital stay when compared to vacuum assisted closure, without compromising survival. We performed a randomized trial to assess the effect of local gentamicin in the treatment of deep sternal wound infection. This trial revealed no reduction of hospital stay in patients treated with local gentamicin. Methods for secondary wound closure were compared. Titanium plate fixation was superior in providing sternal stability when compared to conventional wound closure methods. In the last section of this thesis risk mitigation of deep sternal wound infection is discussed. Tools are provided for risk assessment and evaluation of risk reduction. Our method on prevention, diagnosis and treatment of deep sternal wound infection is described, including the role of a dedicated mediastinitis multi-disciplinary team.