Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting

INTERNATIONAL JOURNAL OF SURGERY

卷:16

Review

Sajja, Lokeswara Rao^1,2 

[1] Star Hosp, Hyderabad 500034, Andhra Pradesh, India

[2] Sajja Heart Fdn, Hyderabad, Andhra Pradesh, India

关键词: Deep sternal wound infection;    Coronary artery bypass grafting;    BIMA;    Internal thoracic artery;    Mediastinitis;   

DOI  :  10.1016/j.ijsu.2014.11.017

来源: Elsevier

【 摘 要 】

Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. Several risk factors have been identified with sternal wound infections and a few are modifiable. Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article. (C) 2014 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

Free