From debridement to definitive closure: an experience-based staged approach to sternal wound infection

Abstract Background Sternal wound infections (SWI) remain a major complication after cardiac surgery and are associated with prolonged treatment courses, repeated operations, and substantial morbidity. Early, structured therapy may reduce the need for complex reconstruction. Methods We conducted a retrospective single-center study of all patients referred to our plastic surgery department for treatment of SWI between May 2017 and December 2019. All patients with SWI underwent surgical debridement, targeted antibiotic therapy, and negative pressure wound therapy with instillation (NPWTi) before definitive reconstruction. Wounds were classified intraoperatively as superficial or deep. Results Sixty-two patients were included. The cohort consisted of 30 men and 32 women, with a mean age of 58.5 years. Coronary artery bypass grafting was the most common preceding procedure (90.3%). Diabetes mellitus (62.9%) and arterial hypertension (56.5%) were the most frequent comorbidities. Fifteen patients had superficial and 47 had deep infections. A single debridement was sufficient in all but one patient. The average duration between sternotomy and debridement was 8 weeks. Definitive closure was achieved most frequently by secondary suturing (67.7%), followed by omental flap reconstruction (16.1%) and pectoralis major flap reconstruction (6.5%). Four patients developed postoperative wound dehiscence after secondary closure and required repeat debridement and NPWTi. No infectious recurrence occurred during follow-up. Overall mortality was 3.2%, both deaths being related to severe sepsis and/or a high comorbidity burden. Conclusions An early stepwise treatment strategy combining early debridement, NPWTi, and selective definitive reconstruction allowed wound closure in most patients without complex flap procedures. Early and adequate management may reduce reconstructive burden and improve clinical outcomes in sternal wound infection. Level of Evidence: Level III, therapeutic study.