Arch Plast Surg.  2019 Jul;46(4):291-302. 10.5999/aps.2018.01151.

Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

  • 1Department of Surgery, Hospital du Valais, Sion, Switzerland.
  • 2Department of Plastic and Reconstructive Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
  • 3Department of Surgery, Hamad General Hospital, Doha, Qatar.
  • 4Department of Cardiac Surgery, Mauriziano Hospital, Turin, Italy.
  • 5Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
  • 6Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.


Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.


Sternum; Infection; Reconstructive surgical procedure; Sternotomy

MeSH Terms

Length of Stay
Reconstructive Surgical Procedures
Software Design
Standard of Care
Thoracic Surgery
Wound Infection*
Wounds and Injuries*
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