Effect of Delayed Sternal Closure on Sternal Wound Debridement after Pediatric Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIXiao-feng , LUODan-dong , ZHUWei-zhong , XIONGWei-ping ,  ZHUANGJian

Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, P. R. China;

Corresponding?author：

ZHUANGJian, Email: zhuangjian5413@tom.com

Keywords：

Delayed sternal closure; Pediatric; Cardiac surgery; Median sternal sternotomy; Debridement

DOI：

10.7507/1007-4848.20150163

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Objective To investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. Methods We retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. Results A total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ²=6.693, P=0.010). Conclusion DSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.

Citation： LIXiao-feng, LUODan-dong, ZHUWei-zhong, XIONGWei-ping, ZHUANGJian. Effect of Delayed Sternal Closure on Sternal Wound Debridement after Pediatric Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(7): 642-645. doi: 10.7507/1007-4848.20150163 Copy

1.	Mastropietro CW, Barrett R, Davalos MC, et al. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery. Ann Thorac Surg, 2013, 95(6):2133-2139.
2.	Bowman ME, Rebeyka IM, Ross DB, et al. Risk factors for surgical site infection after delayed sternal closure. Am J Infect Control, 2013, 41(5):464-465.
3.	Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg, 2013, 146(2):326-333.
4.	Johnson JN, Jaggers J, Li S, et al. Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg, 2010, 139(5):1205-1210.
5.	Shin HJ, Jhang WK, Park JJ, et al. Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg, 2011, 92(2):705-709.
6.	Hashemzadeh K, Hashemzadeh S. In-hospital outcomes of delayed sternal closure after open cardiac surgery. J Card Surg, 2009, 24(1):30-33.
7.	Riahi M, Tomatis La, Schlosser RJ, et al. Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest, 1975, 67(1):113-114.
8.	Gielchinsky I, Parsonnet V, Krishnan B, et al. Delayed sternal closure following open-heart operation. Ann Thorac Surg, 1981, 32(3):273-277.
9.	Samir K, Riberi A, Ghez O, et al. Delayed sternal closure:a life-saving measure in neonatal open heart surgery; could it be predictable? Eur J Cardiothorac Surg, 2002, 21(5):787-793.
10.	Misawa Y. What can be an indicator of delayed sternal closure after cardiac surgery? Eur J Cardiothorac Surg, 2002, 22(3):493-494.
11.	Owens WA, Vitale N, Hasan A, et al. A policy of elective delayed sternal closure does not improve the outcome after arterial switch. Ann Thorac Surg, 2001, 71(5):1553-1555.
12.	Long CB, Shah SS, Lautenbach E, et al. Postoperative mediastinitis in children:epidemiology, microbiology, and risk factors for gram negative pathogens. Pediatr Infect Dis J, 2005, 24(4):315-319.
13.	Fleck T, Kickinger B, Moidl R, et al. Management of open chest and delayed sternal closure with the vacuum assisted closure system:preliminary experience. Interact Cardiovasc Thorac Surg, 2008, 7(5):801-804.
14.	羅國華, 李守軍, 沈向東, 等. 延遲關胸在小兒心臟外科中的應用. 中國胸心血管外科臨床雜志, 2004, 11(4):320.
15.	Tabbutt S, Duncan BW, McLaughlin D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg, 1997, 113(5):886-893.
16.	Estrera AL, Porat EE, Miller CC 3rd, et al. Outcomes of delayed sternal closure after complex aortic surgery. Eur J Cardiothorac Surgery, 2008, 33(6):1039-1042.

1. Mastropietro CW, Barrett R, Davalos MC, et al. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery. Ann Thorac Surg, 2013, 95(6):2133-2139.
2. Bowman ME, Rebeyka IM, Ross DB, et al. Risk factors for surgical site infection after delayed sternal closure. Am J Infect Control, 2013, 41(5):464-465.
3. Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg, 2013, 146(2):326-333.
4. Johnson JN, Jaggers J, Li S, et al. Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg, 2010, 139(5):1205-1210.
5. Shin HJ, Jhang WK, Park JJ, et al. Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg, 2011, 92(2):705-709.
6. Hashemzadeh K, Hashemzadeh S. In-hospital outcomes of delayed sternal closure after open cardiac surgery. J Card Surg, 2009, 24(1):30-33.
7. Riahi M, Tomatis La, Schlosser RJ, et al. Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest, 1975, 67(1):113-114.
8. Gielchinsky I, Parsonnet V, Krishnan B, et al. Delayed sternal closure following open-heart operation. Ann Thorac Surg, 1981, 32(3):273-277.
9. Samir K, Riberi A, Ghez O, et al. Delayed sternal closure:a life-saving measure in neonatal open heart surgery; could it be predictable? Eur J Cardiothorac Surg, 2002, 21(5):787-793.
10. Misawa Y. What can be an indicator of delayed sternal closure after cardiac surgery? Eur J Cardiothorac Surg, 2002, 22(3):493-494.
11. Owens WA, Vitale N, Hasan A, et al. A policy of elective delayed sternal closure does not improve the outcome after arterial switch. Ann Thorac Surg, 2001, 71(5):1553-1555.
12. Long CB, Shah SS, Lautenbach E, et al. Postoperative mediastinitis in children:epidemiology, microbiology, and risk factors for gram negative pathogens. Pediatr Infect Dis J, 2005, 24(4):315-319.
13. Fleck T, Kickinger B, Moidl R, et al. Management of open chest and delayed sternal closure with the vacuum assisted closure system:preliminary experience. Interact Cardiovasc Thorac Surg, 2008, 7(5):801-804.
14. 羅國華, 李守軍, 沈向東, 等. 延遲關胸在小兒心臟外科中的應用. 中國胸心血管外科臨床雜志, 2004, 11(4):320.
15. Tabbutt S, Duncan BW, McLaughlin D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg, 1997, 113(5):886-893.
16. Estrera AL, Porat EE, Miller CC 3rd, et al. Outcomes of delayed sternal closure after complex aortic surgery. Eur J Cardiothorac Surgery, 2008, 33(6):1039-1042.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of Delayed Sternal Closure on Sternal Wound Debridement after Pediatric Cardiac Surgery

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