NOVEL TREATMENT MODALITIES :DSWI

Chawannuch Ruaengsri

Cardiothoracic unit. Ramathibodi hospital

STERNAL WOUND INFECTIONS

Incidence: 1-5% (Loop et al, Ann Thorac Surg

1990)

Mortality: 10-20% (De Feo et al, Ann Thorac Surg

2011)

Increase of costs 3 folds (Loop et al)

TREATMENT OPTIONS

Ancient:

-Mandelbaum and Schumaker 1963: Suction

drainage with antibiotics (Arch Surg)

-Jurkiewicz 1980: Pectoralis muscle flap closure (Ann

Surg)

Today:

-Surgical debridement

-Open wound treatment with secondary closure

-Plastic reconstructive surgery with muscle flap

NEW MODALITIES

FORM

DISSECTION OF PEC MAJOR FROM STERNAL MARGIN

ASSEMBLY OF STERNAL DEVICE (3 UNIT COMPONENT)

TECNIQUE OF IMPLANTATION

TECHNIQUE OF IMPLANTATION

STERNAL REWIRING PLACEMENT OF SINGLE STEEL WIRES

COMPLETED STERNAL REWIRING

RIGID FIXATION SYSTEM

RIGID STERNAL FIXATION

Reconstructive process

Sternal stability (patient comfort, accelerated

healing, decrease incident of paradoxical chest-wall

breathing)

Earlier union from accelerated osseous healing

CASE

A Thai female, 72 years old.

DM poor blood sugar control.

HT

ESRD on HD 3 times/wk

Tracheal granuloma, presenting with stridor

TVD with LM stenosis

S/P

OPCAB *4

Emergency tracheostomy due to fail ventilation

POST OP DAY 18

interhos\Chest Infection.mpg