Progress and milestones in the treatment of deep sternal wound infections

Abstract

Numerous advances have been made during the last half century in the treatment of deep sternal wound infection following sternotomy for open heart surgery. In the early years of cardiac surgery debridement and wound packing was the mainstay of therapy until closed chest drainage with mediastinal irrigation with antibiotics and/or antiseptics was later recommended. Treatment failure and mortality were still high with these techniques until wound coverage with viable tissues such as the greater omentum and the pectoralis major myocutaneous flap began to be applied. During the last 10 years another step ahead has been taken with the introduction of negative wound pressure therapy. This treatment modality is now being proposed following debridement to limit further the extension of sternal osteomyelitis and preserve the sternum for later chest wall reconstruction with horizontal titanium plating.