Deep Sternal Wound Infections
This concise and practical handbook covers the basics of pathophysiology, diagnosis, interdisciplinary surgical management, prevention and rehabilitation of patients with deep sternal wound infections and sternal osteomyelitis. All relevant aspects and su
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Deep Sternal Wound Infections
Deep Sternal Wound Infections
Raymund E. Horch Christian Willy Ingo Kutschka (Eds.)
Deep Sternal Wound Infections
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Editors Raymund E. Horch Universitätsklinikum Erlangen, Erlangen, Germany Christian Willy Bundeswehrkrankenhaus Berlin, Berlin, Germany Ingo Kutschka Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
ISBN 978-3-662-49764-7 DOI 10.1007/978-3-662-49766-1
978-3-662-49766-1 (eBook)
Springer © Springer-Verlag GmbH Germany 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Cover design: deblik Berlin Cover illustration: Prof. Dr. Raymund E. Horch Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer-Verlag GmbH Germany The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany
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Preface Despite recent innovations in smaller incision and less invasive approaches to the heart, the median sternotomy still remains, by far, the most commonly used approach. This incision provides excellent anatomic access to all areas of the heart surface, intra-cardiac structures and the great vessels. The median sternotomy is also an incision that heals very well in most patients and with minimum morbidity. While the future may see fewer open surgical valve repairs or replacements, and particularly in the aortic position, several large recent Trials (SYNTAX, EXCEL, NOBLE) have confirmed the superiority of CABG over stents for most patients with coronary artery disease and certainly those with more severe disease. However, this population also increasingly contains a higher proportion of patients whose co-morbidities, such as diabetes and obesity, may predispose to potentially major sternal wound problems. This is particularly so with the use of two internal mammary arteries which may offer patients, particularly those with Diabetes, better long term outcomes than a single mammary artery but at the cost of increased sternal wound healing problems. Whil
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