Sternal fistula after median sternotomy – surgical treatment in 34 cases

Aims: Sternal fistula occur rarely, but regularly following open heart surgery, often subsequent to sternal wound infection in the early postoperative period. Due to its periodical recurrence with suppurating secretion, chronical osteomyelitis and insufficient effects to antibiotics, sternal fistula not only cause deep dissatisfaction in operated patients, but are also a potential focus for endocarditis after e.g. valve surgery.

Methods: From 2/2001 to 5/2008, 10800 patients received open heart surgery with median sternotomy in our institution. 34 patients (0.3%) with sternal fistula were treated with scar excision, removal of all sternal wires, extensive resection of all infected subcutaneous and bone tissue, primary wound closure after placement of a wound drain for special kind of vacuum therapy for next seven days. Retrospective analysis. Evaluation of predisposing risk factors, kind of previous cardiac surgery, microbiological results, duration between primary cardiac surgery and wound treatment, preoperative diagnostic, intraoperative findings, peri- and postoperative microbiological therapy and specific features concerning postoperative care. Presentation of extensive pictures of intraoperative course.

Results: All patients could get discharged one week after surgery. 31 patients (91.2%) had an uneventful postoperative course without any further impaired wound healing. In 3 patients recurrence of fistula took place one week, nine weeks and three months after surgery. All of these were sent to plastic surgeon for further diagnostic and operation.

Conclusion: Chronic sternal fistula present a rare and stubborn entity after cardiac surgery with median sternotomy. Careful and extensive resection of infected tissue as well as removal of all sternal wires to eliminate infective focus next to consequent antibiotic therapy seems to be a safe, reliable and effective treatment.