Effective isolation of a tracheostomy from a median sternotomy wound

Early percutaneous tracheostomy after median sternotomy

“…By way of minimizing the risk of sternal wound contamination from the tracheostomy, sophisticated sternal wound dressings were developed, presumably eliminating or reducing the risk of wound infection and mediastinitis in patients who underwent either tracheostomy before the sternotomy had healed or sternotomy while having a pre-existing tracheostomy. 3,21,22 Severe tracheostomy infections have been significantly less frequent with percutaneous tracheostomy than with conventional tracheostomy, 4,15,16,19,20,[23][24][25] and only one study demonstrated that no wound infections occurred regardless of whether percutaneous or conventional tracheostomy was performed. 17 The question of whether percutaneous tracheostomy can be performed early after median sternotomy without exposing the patients to the risks of sternal wound infection or mediastinitis has not been answered to date by means of a study in a large number of patients and appropriate microbiologic testing.…”

“…coworkers 3 recommended performance of cricothyroid tracheostomy to effectively isolate the tracheostomy from the sternotomy and to seal the sternal wound until postoperative day 14. In the 1990s, Hübner and coworkers 4 presumed that the risk of postoperative mediastinitis in most departments still leads to a hesitant indication for tracheostomy within the first 2 postoperative weeks.…”