What's New
Aggressive Treatment of Sternal Wounds Leads to Dramatically Improved Patient Outcomes
Over the last 40 years, the treatment of sternal wounds has evolved considerably. Commonly known as the breast bone, the sternum is the long flat bone in the middle of the chest that connects to the ribs. To perform certain cardiothoracic procedures, surgeons often cut open the sternum (sternotomy) to gain access to the heart and/or lungs. Sternal wound complications can arise following cardiac surgery, and can be life-threatening if they are not quickly and carefully treated. A recent clinical review by Jeffrey A. Ascherman, MD, Assistant Professor of Surgery and Site Chief, Division of Plastic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center (NYPH/Columbia) demonstrated that refinements in his treatment techniques have led to a dramatic impact in outcomes for sternal wound patients.
Dr. Ascherman compared the sternal wound treatment of 74 patients (treated by several surgeons at Columbia from 1985-1991) to a second series of 114 patients (all treated by Dr. Ascherman from 1995-2001). The results, which were published in the September 2004 issue of the journal, Plastic and Reconstructive Surgery, revealed a remarkable decrease in morbidity for the second, more recent series of patients from a 39% morbidity rate for the first series to 17% for the second. The patients in Dr. Ascherman's study ranged in age from 8 months to 84 years old at the time of surgery.
"The purpose of this study was to obtain specific outcomes data by reviewing a large series of patients treated by a single surgeon. Although the risk of a sternal wound complication is less than 3%, there is such a large number of cardiac surgeries performed here at Columbia that I have still been able to acquire an extensive amount of experience with these patients," explains Dr. Ascherman. "I wanted to take advantage of my experience by studying the results to see how we have changed our outcomes."
Sternal wounds can develop in very sick patients after any type of cardiac surgery. Patients who are diabetic, immunosuppressed following a heart transplant, or suffering from other medical challenges are particularly at risk. "A sternal wound may not heal properly for a number of reasons. Typically, it's because of infection. To help treat the wound, I clean off the edges of the sternal bone, and then I bring muscles from both sides of the chest into the space around the sternal bone to help fight the infection," says Dr. Ascherman.
"We have made a number of refinements in our treatment protocol over the past several years. Overall, a tailored approach is our point of distinction. I don't prescribe to doing the exact same surgical approach for all patients, as some physicians do. I decrease the amount of dissection by tailoring the procedure to the patient's specific problem. This results in less operating time, less trauma to the patient, and decreased hematomas (blood clots) and seromas (fluid collections)."
Dr. Ascherman believes the best way to treat these wounds is aggressively. "One of the reasons our procedure is so effective is that we employ an aggressive approach. Many physicians do more complicated muscle flaps, longer surgeries, and perform staged (multi-part) procedures. I prefer to avoid the multi-staged, more extensive surgeries that may involve more complications and much longer hospitalization. I normally do everything at once. After being consulted, I take patients to the operating room as soon as possible to treat the wound. In most patients, it's a single-stage procedure that takes two hours or less."
Dr. Ascherman concludes, "If we treat sternal wounds aggressively, the functional and aesthetic results of our technique are generally excellent. Our way has proven to be simpler and more effective than previous approaches. Most importantly, our patients are greatly benefiting from the adjustments in our technique. We have made significant progress in serving a patient population frequently afflicted with numerous co-morbidities."
|
