Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting

Abstract

Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. Several risk factors have been identified with sternal wound infections and a few are modifiable. Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article.

Advantages and disadvantages of total arterial coronary artery bypass graft as compared to venous coronary artery bypass graft

“…In the sensitivity analysis, the difference in favour of skeletonized ITA was also observed in subgroups such as diabetic, bilateral ITA and diabetic with bilateral ITA; also, there was a difference in the type of study, since non-randomized studies together demonstrated the benefit of skeletonized ITA in comparison with pedicled ITA, but the randomized studies together did not show this difference [28] . To summarize, strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control, while surgical strategies reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques [29] . Antibiotic prophylaxis given to patients pre-and post-operatively helps further reduce the chance of wounds infection, improving the surgical prognosis.…”

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

“…Kamiya et al [28] showed that the oxygen saturation and blood flow in the microcirculation of the sternum tissue were better when using the skeletonized ITA compared to pedicled ITA. Despite the beneficial impact of skeletonization on reducing the risk of sternal wound infection it is important to emphasize that skeletonization is technically more demanding and more time-consuming than pedicled ITA harvesting with a steep learning curve associated with it [29-31] . Furthermore, some surgeons have raised concerns about the quality of the graft, mainly when it comes to the patency and the flow capacity of the skeletonized ITA.…”

Effect of LIMA Harvesting Technique on Postoperative Drainage in Off-Pump CABG

“…Sá et al [ 15 ] reported that skeletonized LIMA harvesting should be considered in diabetic patients. Sajja [ 16 ] determined that cessation of smoking, optimal control of hyperglycemia, sterile operative condition, use of appropriate antibiotics, appropriate internal mammary artery harvesting, and sternal closure reduced mediastinitis.…”