Exploring the Complications of Sternal Wound Infection Following Cardiac Surgery

Benjamin Ziegler^*
*Correspondence: Benjamin Ziegler, Department of Cardiovascular Surgery, University Hospital Zurich, Swaziland, Email:

Introduction

Sternal Wound Infection (SWI) is one of the most concerning complications that can arise following cardiac surgery. This complication typically occurs after procedures such as Coronary Artery Bypass Grafting (CABG) or heart valve surgeries, where the chest is surgically opened to access the heart. Despite significant advances in surgical techniques, sterilization practices and post-operative care, sternal wound infections continue to pose a major challenge for both patients and healthcare providers. These infections not only hinder the recovery process but can lead to more severe complications such as osteomyelitis, mediastinitis and sepsis, which can result in increased morbidity, prolonged hospital stays and even death. Understanding the pathophysiology, risk factors, clinical manifestations, diagnostic methods, treatment strategies and prevention measures for sternal wound infections is crucial for minimizing their impact and improving patient outcomes. This paper delves into the complexities of sternal wound infections, exploring how they develop, their potential complications and the latest advances in managing and preventing this troubling issue in post-cardiac surgery patients [1].

Description

Sternal wound infections arise when microorganisms, typically bacteria, enter the surgical site after cardiac surgery, where the sternum has been divided to access the heart. The most common culprits of these infections are Staphylococcus aureus and Staphylococcus epidermidis, which are part of the skin's natural flora and can easily be transferred to the wound during surgery or post-operatively. The infection may initially affect only the superficial layers of the wound but can progress to deeper structures, including the sternum itself. When the infection spreads to the bone, it can lead to osteomyelitis, while infection of the central chest cavity (mediastinum) can lead to mediastinitis, both of which significantly complicate recovery [2]. Several risk factors contribute to the likelihood of developing sternal wound infections. Patient-related factors, such as diabetes, obesity and immunosuppression, increase vulnerability to infection due to impaired immune response and poor wound healing. Furthermore, the presence of an active infection during surgery or extended surgical duration can exacerbate the risk. Surgical factors such as improper closure, inadequate sterilization, or post-operative care practices also play a role in the development of these infections. Early clinical signs of a sternal wound infection include redness, swelling, pain, fever and the presence of discharge from the wound. If left untreated, these infections can lead to more severe complications like sepsis, osteomyelitis, or mediastinitis, which are potentially life-threatening [3]. Diagnosing sternal wound infections typically involves a thorough clinical evaluation, followed by diagnostic tests such as wound cultures, blood tests and imaging studies like chest X-rays or CT scans. Cultures help identify the bacterial pathogens causing the infection, while blood tests may reveal elevated white blood cell counts and inflammatory markers indicative of infection. Imaging studies are used to assess the spread of the infection and detect any underlying complications like mediastinitis. Once diagnosed, treatment strategies range from conservative antibiotic therapy for mild infections to more aggressive approaches, including surgical debridement for severe infections that involve deeper tissues. In many cases, regular wound care, including appropriate dressing changes, is essential in supporting healing and preventing further infection [4]. Prevention of sternal wound infection begins before the surgery even takes place. Key preventive measures include administering prophylactic antibiotics, using optimal surgical techniques to minimize contamination and ensuring meticulous post-operative wound care. Management of pre-existing conditions like diabetes and obesity can significantly improve outcomes by promoting better wound healing. Additionally, timely detection of any early signs of infection allows for prompt intervention, reducing the likelihood of more severe complications [5].

Conclusion

Sternal wound infection remains one of the most challenging complications following cardiac surgery, with the potential to lead to severe consequences if not addressed promptly and effectively. While the incidence of these infections has decreased due to improvements in surgical practices and post-operative care, they still present a significant risk to patients, particularly those with underlying comorbidities. Early detection, appropriate treatment and preventive strategies are essential in managing these infections and preventing them from progressing to more severe complications like osteomyelitis or mediastinitis. By focusing on optimal surgical techniques, proper wound care and managing patient-specific risk factors, healthcare providers can reduce the occurrence of sternal wound infections and enhance recovery outcomes for cardiac surgery patients. As research continues to explore new technologies and treatment options, the hope is that we can further reduce the incidence of this complication and improve the long-term health of those undergoing heart surgery

References

1. Tang, Gilbert HL, Manjula Maganti, Richard D. Weisel and Michael A. Borger. "Prevention and management of deep sternal wound infection." Semin Thorac Cardiovasc Surg 16 (2004): 62-69.

Google Scholar, Crossref, Indexed at

2. Gatti, Giuseppe, Luca Dell'Angela, Giulia Barbati and Bernardo Benussi, et al. "A predictive scoring system for deep sternal wound infection after bilateral internal thoracic artery grafting." Eur J Cardio-Thoracic Surg 49 (2016): 910-917.

Google Scholar, Crossref, Indexed at