Novel Treatment Options for Deep Sternal Wound Infections Using Human Allograft

Introduction: Open heart surgery is becoming more prevalent with the aging population. As technology improves with significant medical advancements, the contraindications for open heart surgery continue to decrease. Although patients with advanced age or multiple medical comorbidities can successfully undergo coronary artery bypass grafting and/or valve replacement, there are potential risks during the postoperative period. One of the most dreaded complications includes deep sternal wound infections which can also be associated with sternal dehiscence or nonunion. Definitive treatment of these complications often involves radical debridement with or without sternal stabilization and flap reconstruction. Despite these reconstructive options, there remains a high risk of continued complications resulting in substantial morbidity and even death. The advent of meshed human reticular dermis (HR-ADM) and dehydrated human aminon and chorion mini-membrane (dHACM) may offer an additional option to augment healing in this patient population.Methods:A prospective review of a single surgeon experience of patients undergoing surgical management of complicated sternal wounds using meshed human reticular dermis and dehydrated placental mini-membrane was performed. Patient demographics including age, body mass index (BMI), and medical comorbidities were recorded, as well as, postoperative outcomes.Results:A total of three patients underwent surgical treatment of deep sternal wound infections using meshed human reticular dermis and/or dehydrated human amnion and chorion mini-membrane over the past 6 months. Two patients also had sternal nonunion and the third patient presented with extrusion of the sternal wires. The two patients with nonunion underwent sternal plating with bilateral pectoralis muscle advancement flaps while the third patient was deemed a poor candidate for flap reconstruction and only underwent debridement with removal of the exposed hardware. HR-ADM and dHACM was used and all patients demonstrated complete healing of the sternum and soft tissue wounds.Discussion: Mediastinitis with deep sternal wounds is one of the most dreaded complications after open heart surgery which causes significant morbidity and mortality. Moreover this patient population often suffers from other significant medical comorbidities which further increases the risks of complications despite aggressive medical and surgical treatments. The use of meshed human reticular dermis and dehydrated human placental mini-membrane provides a novel addition to the treatment options to promote healing in patients presenting with complex sternal wounds.References: