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Deep Sternal Wound Infections
Raymund E. HorchChristian WillyIngo Kutschka(Eds.)
Deep Sternal Wound
Infections
123
ISBN 978-3-662-49764-7 978-3-662-49766-1 (eBook)DOI 10.1007/978-3-662-49766-1
Springer© Springer-Verlag GmbH Germany 2016This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.
Cover design: deblik BerlinCover illustration: Prof. Dr. Raymund E. Horch
Printed on acid-free paper
This Springer imprint is published by Springer NatureThe registered company is Springer-Verlag GmbH GermanyThe registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany
EditorsRaymund E. HorchUniversitätsklinikum Erlangen, Erlangen, Germany
Christian Willy Bundeswehrkrankenhaus Berlin, Berlin, Germany
Ingo Kutschka Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
V
Preface
Despite recent innovations in smaller incision and less invasive approaches to the heart, the median sternotomy still remains, by far, the most commonly used approach. This incision provides excellent anatomic access to all areas of the heart surface, intra-cardiac structures and the great vessels. The median sternotomy is also an incision that heals very well in most pa-tients and with minimum morbidity.
While the future may see fewer open surgical valve repairs or replacements, and particularly in the aortic position, several large recent Trials (SYNTAX, EXCEL, NOBLE) have confirmed the superiority of CABG over stents for most patients with coronary artery disease and cer-tainly those with more severe disease. However, this population also increasingly contains a higher proportion of patients whose co-morbidities, such as diabetes and obesity, may predis-pose to potentially major sternal wound problems. This is particularly so with the use of two internal mammary arteries which may offer patients, particularly those with Diabetes, better long term outcomes than a single mammary artery but at the cost of increased sternal wound healing problems. While advances in wound management have reduced the previously high mortality associated with sternal dehiscence, major wound complications can still lead to other important clinical problems and prolonged hospital stay, with their very expensive adverse economic sequelae.
The authors should therefore be congratulated on the content and timeliness of this current text book. It comprehensively covers all aspects of sternal wound management from patho-physiology and predispositions to diagnoses and treatment of complications. It reviews the latest invasions and technologies that may potentially reduce, or indeed prevent, sternotomy wound complications. The book makes ideal reading for all who are involved in the care of such patients.
David P. Taggart MD (Hons), PhD, FRCS, FESC
Professor of Cardiovascular SurgeryUniversity of Oxford
Table of content
1 Definition, Classification, and Epidemiology of Sternal Osteomyelitis . . . . . 1Patrick Zardo and Ingo Kutschka
2 Anatomy and Blood Supply of the Sternum . . . . . . . . . . . . . . . . . . . . . . . . . 7Winfried Neuhuber, Stefan Lyer, Christoph Alexiou and Thomas Buder
3 Pathophysiology of Sternal Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . 13Patrick Zardo and Ingo Kutschka
4 Stabilization of Thoracic Wall and Ventilatory Function
by Negative Pressure Wound Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Patrick Zardo, Bernhard Fleischer and Ingo Kutschka
5 Radiological Diagnostics of Postoperative Sternal Osteomyelitis . . . . . . . . . 21Björn Friebe, Ivayla Apostolova and Jens Ricke
6 Microbiological Aspects and Epidemiological Data of Poststernotomy
Deep Sternal Wound Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Christian Willy, Marcus Stichling, Catharina Scheuermann-Poley, André Lieber, Onnen Grauhan and Martin Mueller
7 Primary Wound Management of Poststernotomy Infection . . . . . . . . . . . . . 37Onnen Grauhan
8 Negative Pressure Wound Therapy in Poststernotomy Deep Sternal
Wound Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Christian Willy, Catharina Scheuermann-Poley, Marcus Stichling, Onnen Grauhan and André Lieber
9 Bone Stabilization Methods After Sternal Osteotomy . . . . . . . . . . . . . . . . . 75Onnen Grauhan
10 Principles of Plastic Surgery in Sternal Osteomyelitis . . . . . . . . . . . . . . . . . . 83Raymund E. Horch
11 Plastic Surgical Methods of Defect Coverage in Sternal Osteomyelitis
with Pedicled Flaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Andreas Arkudas, Justus P. Beier and Raymund E. Horch
12 Indications for Free Flap Coverage and Interdisciplinary
Combined Approaches with Vascular Surgery AV Loops . . . . . . . . . . . . . . . . 101Justus P. Beier, Andreas Arkudas and Raymund E. Horch
VIITable of content
13 Anesthesiological Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Thomas Hachenberg
14 Rehabilitation After Sternal Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . 115Axel Schlitt and Ingo Kutschka
15 Prevention of Poststernotomy Wound Infections by Closed Incision
Negative Pressure Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Onnen Grauhan and Christian Willy
Servicepart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Editors
Horch, Raymund E.,
Prof. Dr. med. Dr. h.c. Prof. h.c.
DirektorPlastisch und Handchirurgische KlinikUniversitätsklinikum ErlangenFriedrich Alexander Universität Erlangen- Nürnberg FAUKrankenhausstraße 1291054 [email protected]
Kutschka, Ingo, Prof. Dr. med., MBA
KlinikdirektorKlinik für Herz- und ThoraxchirurgieOtto-von-Guericke-Universität MagdeburgLeipziger Str. 4439120 [email protected]
Willy, Christian, Prof. Dr. med.
Leiter der KlinikKlinik für Orthopädie und Unfallchirurgie,Septisch und Rekonstruktive ChirurgieBundeswehrkrankenhaus BerlinAkademisches Lehrkrankenhaus der CharitéScharnhorststraße 1310115 [email protected]
IX
Authors
Alexiou, Christoph, Prof. Dr. med.
Sektion für Experimentelle Onkologie und Nanomedizin (SEON)Glückstraße 10a91054 Erlangen [email protected]
Apostolova, Ivayla, Priv.-Doz. Dr. med.
Zentrum für RadiologieUniversitätsklinik für Radiologie und NuklearmedizinNuklearmedizinOtto-von-Guericke-Universität MagdeburgLeipziger Straße 44 39120 Magdeburg
Arkudas, Andreas, Priv.-Doz. Dr. med.
Geschäftsführender OberarztPlastisch und Handchirurgische KlinikUniversitätsklinikum ErlangenFriedrich Alexander Universität Erlangen- Nürnberg FAUKrankenhausstraße 1291054 [email protected]
Beier, Justus P., Prof. Dr. med.
Leitender OberarztPlastisch und Handchirurgische KlinikUniversitätsklinikum ErlangenFriedrich Alexander Universität Erlangen- Nürnberg FAUKrankenhausstraße 1291054 [email protected]
Buder, Thomas, Dr. rer. nat.
Institut für Anatomie IUniversität Erlangen-NürnbergKrankenhausstr. 9D-91054 [email protected]
Fleischer, Bernhard, Dr. med.
Klinik für Herz- und ThoraxchirurgieOtto-von-Guericke-Universität MagdeburgLeipziger Straße 4439120 [email protected]
Friebe, Björn, Dr. med.
Zentrum für RadiologieUniversitätsklinik für Radiologie und NuklearmedizinRadiologieOtto-von-Guericke-Universität MagdeburgLeipziger Straße 4439120 Magdeburg [email protected]
Grauhan, Onnen,
Prof. Dr. med. Dr. h.c., MBA
Klinik für Herz-, Thorax- und GefäßchirurgieDeutsches HerzzentrumAugustenburger Platz 113353 [email protected]
Hachenberg, Thomas, Prof. Dr. med.
Klinikdirektor Klinik für Anaesthesiologie und IntensivtherapieOtto-von-Guericke-Universität MagdeburgLeipziger Straße 4439120 [email protected]
Lieber, André, Dr. med.
Sektionsleiter Thoraxchirurgie derKlinik für Orthopädie und Unfallchirurgie,Septisch und Rekonstruktive ChirurgieBundeswehrkrankenhaus BerlinAkademisches Lehrkrankenhaus der CharitéScharnhorststraße 1310115 [email protected]
X Authors
Lyer, Stefan, Dr. rer. nat.
Stellvertretender Leiter von SEON; Wissenschaftlicher Mitarbeiter (Biologe) im Bereich Onkologie und [email protected]
Mueller, Martin, Dr. med.
AbteilungsleiterZentrales Institut des Sanitätsdienstesder Bundeswehr Kiel / Ast BerlinLaborabteilung I Medizin amBundeswehrkrankenhaus BerlinAkademisches Lehrkrankenhaus der CharitéScharnhorststraße 1310115 [email protected]
Neuhuber, Winfried, Prof. Dr. med.
Institut für Anatomie IUniversität Erlangen-NürnbergKrankenhausstr. 991054 [email protected]
Ricke, Jens, Prof. Dr. med.
Klinikdirektor Zentrum für RadiologieKlinik für Radiologie und NuklearmedizinOtto-von-Guericke-Universität MagdeburgLeipziger Str. 4439120 [email protected]
Scheuermann-Poley, Catharina, Dr. med.
Klinik für Orthopädie und Unfallchirurgie,Septisch und Rekonstruktive ChirurgieBundeswehrkrankenhaus BerlinAkademisches Lehrkrankenhaus der CharitéScharnhorststraße 1310115 [email protected]
Schlitt, Axel, Prof. Dr. med. habil., MHA
Leitender Chefarzt und Chefarzt Kardiologie, DiabetologieParacelsus-Harz-Klinik Bad SuderodeParacelsusstraße 106485 [email protected]
Stichling, Marcus, Dr. med.
Klinik für Orthopädie und Unfallchirurgie,Septisch und Rekonstruktive ChirurgieBundeswehrkrankenhaus BerlinAkademisches Lehrkrankenhaus der CharitéScharnhorststraße 1310115 [email protected]
Taggart, David P.,
MD (Hons), PhD, FRCS, FESC
Professor of Cardiovascular SurgeryUniversity of OxfordNuffield Department of Surgical SciencesJohn Radcliffe HospitalHeadingtonOxford, OX3 9DUDavid (RTH) OUH [email protected]
Zardo, Patrick, Dr. med.
Bereichsleiter ThoraxchirurgieKlinik für Herz- und Thoraxchirurgie Otto-von-Guericke-Universität MagdeburgLeipziger Straße 4439120 [email protected]