Primary or delayed closure for the treatment of poststernotomy wound infections?

Objective: The methods of primary versus delayed wound closure for the treatment of sternal wound infections after cardiac surgery were retrospectively compared. Methods: From January 2001 to March 2003, 132 patients (median age 66 years, male to female ratio 88:44),with sternal wound infection after cardiac surgery were treated at our department. After thorough debridement, 35 patients received preconditioning of the wound before implementation of definitive-therapy; the remainder (97 patients) were treated with immediate closure. Results: From the 35 patients with preconditioning, 19 patients proceeded to delayed primary closure, whereas the remaining 14 patients were referred to plastic reconstruction with a pectoralis muscle flap. Primary success rate in this group was 100%. In the immediate primary closure group, 33 patients experienced 1 or more therapy failures, resulting in a recurrence rate of 39%. Fifteen patients received a pectoralis muscle flap as definite treatment modality. Conclusions: Immediate primary closure is associated with a high rate of local infection recurrence. Surgical debridement and conditioning of the wound until resolution of infections with delayed primary closure or plastic reconstruction is suggested as the more appropriate treatment modality, with promising results.