Sternal WoundInfections inPatients After Coronary Artery Bypass Grafting UsingBilateral Skeletonized Internal MammaryArteries

summary, routine use of bilateral skeletonized IMAs seems to be safe in patients undergoing CABG, not only interms of morbidity and mortality rates but also in terms ofsternal complications andinfections. However, in patients withchronic lung disease, the risk ofsternal infection is still unac-ceptably high; for themweadvocate the use ofa single IMAplus saphenous vein grafts instead of bilateral IMAs. Thisapproach is our considered opinion, given that we did notdemonstrate anydecrease in sternal complications in patientswith chronic lung disease whounderwent the more conven-tional IMAplus saphenous vein graft CABGoperations.Despite the increased rate of superficial infections inwomenand in patients with peripheral vascular disease orchronic renal failure, wedo not think this relatively minorcomplication justifies abandoning the use ofdouble skele-tonizedIMAsinthese subgroupsofpatients. Theavoidanceof cautery when opening the skin, or the use of specialbandagingtechniques to avoidbreastpressure onthe sutureline might decrease the occurrence of this complication.Because superficial infection can also occur in a leg inci-sion, wedonotbelievethatusingsaphenousveingrafts willdecrease the rate of morbidity in these subgroups of pa-tients. Therefore, unlike our recommendation for patientswithchronic lungdisease, wedonotrecommendthe useofsingle IMAand vein grafting for womenand for patientswith peripheral vascular disease or chronic renal failure.