Deep Sternal Infection Following Bilateral Internal Thoracic Artery Grafting

Deep sternal wound infection (DSWI) is a serious complication after cardiac surgery. Risk factors include patient-related conditions (obesity, female sex, age, chronic obstructive pulmonary disease, diabetes, carriage of Staphylococcus aureus on the skin) and surgical aspects (paramedian sternotomy, re-exploration for bleeding, prolonged ventilation). Patients receiving bilateral internal thoracic artery (BITA) grafts have better long-term outcomes but also a higher risk of sternal wound complications, as consequence of a complete sternal devascularization. This problem may be prevented by skeletonization of BITA grafts. Other useful precautions are presurgical bathing with chlorhexidine, as well as the identification and prevention of all preoperative and perioperative risk factors, including surgical techniques, rapid extubation, and early removal of catheters. Surgical treatment for DSWI includes many different techniques, depending on wound degree and institutional policy.