Effect of bilateral internal thoracic artery harvesting on deep sternal wound infection in diabetic patients: Review of literature

Abstract

Instead of its documented superiority of patency and long-term outcomes, the bilateral internal thoracic artery grafts are underused in the general population, and its use is controversial and debatable in diabetic patients due to long surgery duration, post-surgical bleeding, and sternal wound complications such as sternal wound infection, mediastinitis, and sternal wound dehiscence. This review article is particularly focused on deep sternal wound infection (DSWI) of bilateral internal thoracic artery (BITA) grafts in diabetic patients with comparison to single internal thoracic artery (SITA) graft.

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

“…However, the use of BITA may play a role in the development of DSWI because the vascularisation of both sides of the sternal wound is compromised. Techniques aiming to preserve a better sternal vascularisation such as skeletonisation or the use of harmonic scalpel have developed over the years [ 241 ].…”

Sternal wound infections following internal mammary artery grafts for a coronary bypass: A meta‐analysis

“…Additionally, the type of sternal wound infection did not affect the chance of developing it. After a single internal mammary artery procedure, a significant risk reduction was shown in several other meta‐analyses that focused on either superficial or deep sternal wound infections, for example, severe wound healing disorder or mediastinitis 39–44 . Age, body mass index (BMI), ejection fraction, gender, diabetes mellitus, smoking, peripheral arterial occlusive disease and chronic renal insufficiency were the key factors separating the populations in these examinations with a single internal mammary artery and those with bilateral internal mammary arterys 8,9,12,14,17 .…”

“…After a single internal mammary artery procedure, a significant risk reduction was shown in several other meta-analyses that focused on either superficial or deep sternal wound infections, for example, severe wound healing disorder or mediastinitis. [39][40][41][42][43][44] Age, body mass index (BMI), ejection fraction, gender, diabetes mellitus, smoking, peripheral arterial occlusive disease and chronic renal insufficiency were the key factors separating the populations in these examinations with a single F I G U R E 7 The effect's forest plot of the bilateral internal mammary artery compared to single internal mammary artery on sternal wound infection in pedicled preparation in personals with coronary artery bypass grafting.…”

Bilateral Pectoralis Major Muscle Flaps in Treating Deep Sternal Wound Infection following CABG in Diabetic Patients: Two Case Reports

“…Therefore, both use of the IMA and diabetes mellitus have been shown to be the independent predictors of DSWI. The incidence of DSWI in diabetic patients following CABG is approximately 8.1%-3.9% higher than that in non-diabetic patients [7]. DSWI after CABG in diabetes is a complex treatment challenge.…”

“…( 6) Adequate drainage between sternum and subcutaneous is critical. (7) The chest band should be compressed for at least 3 months after surgery to maintain the stability of the thorax. ( 8) Appropriate and timely antibiotics, especially for patients with MRSA, should be instituted, to adequately treat the appropriate organisms.…”