Alternative Strategy for Treating Deep Sternal Wound Infection Following Coronary Artery Bypass Grafting with Retention of the Sternal Plating System, Systemic Antibiotics, and Vacuum Assisted Closure System: A Case Report

Abstract

Sternal wound infection (SWI) is an uncommon but potentially fatal complication of cardiac surgery following median sternotomy. It has a considerable impact on in-hospital morbidity and mortality, duration of hospital stay, mid-long term survival, and considerable financial concerns. The traditional approach to treating SWI involves removal of all foreign hardware, surgical debridement, and subsequent sternal reconstruction and long-term intravenous antibiotics. The therapy itself is associated with significant complications including chronic concerns for chest wall integrity, morbidity, and occasionally mortality. In this Case, report, we describe an alternative strategy for deep sternal wound infection treatment that maintains sternal integrity by retention of the sternal plating system, soft tissue debridement, use of a vacuum-assisted closure system, and systemic antibiotics. anesthesia. given IV 1500mg of vancomycin and 2g of Cefazolin intra-operatively as part of the antibiotic prophylaxis protocol. Sternotomy was performed which was followed by open harvesting of Left Internal Mammary Artery (LIMA) and endoscopic harvesting of Saphenous Venous Graft (SVG). The aorta and right atrium were cannulated for Cardio Pulmonary Bypass (CPB). A normotensive CPB was initiated and a pump assisted beating heart five-vessel CABG was performed: SVG to Diagonal, Obtuse Marginal-1, Obtuse Marginal-2 and PDA, while LIMA to LAD. Ventilation was resumed and patient was weaned off CPB after a total time of 134 minutes. Trans-esophageal