Background: Post sternotomy sternal wound infection is a difficult problem to manage and carries significant morbidity and mortality. Multiple different management strategies are considered acceptable depending on the severity of the infection and underlying patient factors. Risk factors in adults differ significantly from those in adults. The role of vacuum assisted closure has been studied in adults, however data on patients with congenital heart disease (CHD) undergoing surgery is limited.

We present our experience with sternal wound infections in patients with CHD.

Methods: From 2012 to 2019 a total of 10,054 patients underwent median sternotomy for congenital heart disease (CHD) surgery. Of these 14 developed a sternal wound infection. The infections were classified as superficial (SSWI), deep (DSWI) or deep sternal wound infection with mediastinitis (DSWI-M). Management strategy was standardized and after local wound cultures had been taken, antibiotics initiated, and the patient was taken to the operating room for initial debridement and vacuum assist closure device (VAC) application. Once the wound was clean and the granulation tissue was flourishing the wound was closed secondarily; either directly or with a myo-cutaneous flapclosure.

Results: 14 patients (5 male and 9 female) presented with a sternal wound infection. The mean age was 31 months (ranging from 3-168 months). The median weight was 9.8 kg (3.9-27 kg). Mean presentation with wound infection symptoms was 11.6 days (5- 28 days) after initial surgery. There was one mortality (1/14) 7.1% that was due to systemic sepsis. Superficial sternal wound infections SSWI occurred in 3 patients, while 9 had deep sternal wound infections, and 2 patients had a DSWI-M. Average hospital stay was 29.1 days (9-148 days) and the number of VAC changes per patient averaged to 3.8 (2-7). Nine patients had a delayed secondary closure, while 4 required a local (pectoralis major) myo-cutaneous advancement flap closure after VAC treatments.

Conclusions: Sternal wound infections remain a postoperative problem with significant morbidity, prolonged hospitalization, and cost. VAC assisted closure is a successful strategy that leads to good control of local wound sepsis as well as deep mediastinitis, post cardiac surgery in patients with CHD. It shortens hospital stay, decreases morbidity and mortality and successful delayed secondary closure can then be done using either a direct closure or more complex closure depending on the degree of sternal breakdown from the infection.