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Eur J Cardiothorac Surg 2002;21:831-839
© 2002 Elsevier Science NL

Review

Disruption and infection of median sternotomy: a comprehensive review

Department of Surgery, M580 Health Sciences Center, University of Missouri–Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA

Received 26 October 2001; received in revised form 21 February 2002; accepted 22 February 2002.

* Corresponding author. Fax: +1-573-884-4585
e-mail: jonesjw{at}health.missouri.edu

Disruption and infection of median sternotomy wounds are grave complications often associated with prolonged hospitalization, high cost, and significant mortality. Effective prevention techniques are still debated. Successful management requires early recognition based on a high index of suspicion, detailed physical examination, appreciation of the clinical signs and symptoms, timely imaging studies, and prompt surgical therapy. Improvements in perioperative management and critical care of patients with multisystem organ failure can reduce morbidity and mortality rates. Sternal salvage and direct sternal reclosure are possible when the infection is diagnosed early. Techniques utilizing lateral sternal support should be first-line options in the condition. Muscle flap techniques should be the next consideration when direct closure has failed or cannot be attempted.

Key Words: Median sternotomy • Disruption • Infection • Mediastinitis • Microbiology • Surgery • Techniques

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