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Infection, Sternal Debridement and Muscle Flap

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Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

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Abstract

Deep sternal wound infection is a rare but serious complication of cardiac operations performed through a median sternotomy. The incidence ranges from 0.75 to 1.44% in large observational studies. Staphylococcus aureus and coagulase negative Staphylococci are the most commonly encountered pathogens. Pedicled bilateral internal mammary artery harvest increases the risk of sternal wound infection, particularly in obese, diabetic patients. The diagnosis of deep sternal wound infection is essentially clinical, but computed tomography can help determine the precise location and extent of the infectious process. Intravenous antibiotics and surgical debridement is the mainstay of therapy. Sternal re-closure can be performed immediately after debridement, or following an interval of open chest management. Sternal closure is achieved either primarily (with cerclage or rigid fixation) or with the use of soft-tissue flaps. Vacuum-assisted closure therapy may improve outcomes.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Amine Mazine & Terrence M. Yau

  2. Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

    Stefan O. P. Hofer

  3. University Health Network, Toronto, ON, Canada

    Stefan O. P. Hofer & Terrence M. Yau

Authors
  1. Amine Mazine
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  2. Stefan O. P. Hofer
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  3. Terrence M. Yau
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Corresponding author

Correspondence to Terrence M. Yau .

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Editors and Affiliations

  1. Distinguished University Professor Department of Anesthesia and Perioperative Medicine and Department of MedicineDivision of Critical Care Medicine, London Health Sciences Center and St Joseph’s Healthcare London Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI) Western University, London, ON, Canada

    Davy C.H. Cheng

  2. Associate Professor Department of Anesthesia and Perioperative Medicine and Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI) Western University, London, ON, Canada

    Janet Martin

  3. Professor of Surgery University of Toronto, Melanie Munk Chair of Cardiovascular Surgery University Health Network, Toronto, ON, Canada

    Tirone David

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Mazine, A., Hofer, S.O.P., Yau, T.M. (2021). Infection, Sternal Debridement and Muscle Flap. In: Cheng, D.C., Martin, J., David, T. (eds) Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-47887-2_57

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  • DOI: https://doi.org/10.1007/978-3-030-47887-2_57

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47886-5

  • Online ISBN: 978-3-030-47887-2

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