A comparison of the open and closed methods in the initial treatment of sternal wound infections.

To determine the optimal initial treatment method for sternal wound infections, a retrospective review of 3,229 consecutive adult open heart operations was performed. There were 40 deep sternal wound infections (1.2%). All types of open heart procedures had approximately the same rate of infection except for left ventricular aneurysm repair plus coronary artery bypass grafting, which had a sternal wound infection rate of 5.8% (p less than 0.01). The use of single and double internal mammary artery grafts did not increase the rate of sternal wound infections. Treatment outcome was available for 39 patients. Twenty-eight patients were initially treated with debridement and closed mediastinal irrigation, which had a failure rate of 42% and a mortality rate of 35%. Six patients were initially treated with debridement, open packing, and muscle flap closure of the sternal wound. No deaths or treatment failures occurred in this group. The mortality and failure rates for the open treatment method were significantly better than for the closed treatment method in the initial treatment of sternal wound infections (p less than 0.05). These data, as well as a review of the literature, suggest that the open method is superior to the closed method in the initial treatment of deep sternal wound infections.