TY - JOUR
T1 - Sternoclavicular joint infection
T2 - A comparison of two surgical approaches
AU - Puri, Varun
AU - Meyers, Bryan F.
AU - Kreisel, Daniel
AU - Patterson, G. Alexander
AU - Crabtree, Traves D.
AU - Battafarano, Richard J.
AU - Krupnick, Alexander S.
PY - 2011/1
Y1 - 2011/1
N2 - Background This study compares conventional open debridement with the recently proposed flap closure technique for sternoclavicular joint infection. Methods This is a retrospective review of patients undergoing surgery for sternoclavicular joint infection during the last 7 years. Results Twenty patients underwent 35 operations for sternoclavicular joint infection from 2002 to 2009. The debridement and open wound procedure (10 of 20 patients, 50%) involved debridement of the clavicle, manubrium, and first rib and open wound care. The joint resection and flap closure procedure (10 of 20 patients, 50%) involved partial resection of the clavicle, manubrium, and first rib, with immediate (9 of 10) or early (1 of 10) wound closure with pectoralis major advancement flap. The two groups were comparable in comorbidities, duration of symptoms, radiologic findings, and microbiologic results. Despite an approach of planned reoperation for wound care, the open group had fewer mean procedures performed per patient (1.6 ± 0.7 versus 1.9 ± 1.6), owing to fewer unplanned procedures (0 versus 0.8 procedures/patient) than the flap group. The incidence of wound complications (hematoma, seroma) was lower in open patients (0 of 10 versus 5 of 10). The median length of hospitalization was shorter in the open group (5.5 versus 10.5 days), but all open patients (10 of 10; 100%) required prolonged wound care compared with 2 of 10 (20%) in the flap group. The only hospital mortality occurred in the flap group. Eventual wound healing was satisfactory in all survivors. Conclusions For sternoclavicular joint infection, a single-stage resection and muscle advancement flap leads to a higher incidence of complications. Debridement with open wound care provides satisfactory outcomes with minimal perioperative complications but requires prolonged wound care.
AB - Background This study compares conventional open debridement with the recently proposed flap closure technique for sternoclavicular joint infection. Methods This is a retrospective review of patients undergoing surgery for sternoclavicular joint infection during the last 7 years. Results Twenty patients underwent 35 operations for sternoclavicular joint infection from 2002 to 2009. The debridement and open wound procedure (10 of 20 patients, 50%) involved debridement of the clavicle, manubrium, and first rib and open wound care. The joint resection and flap closure procedure (10 of 20 patients, 50%) involved partial resection of the clavicle, manubrium, and first rib, with immediate (9 of 10) or early (1 of 10) wound closure with pectoralis major advancement flap. The two groups were comparable in comorbidities, duration of symptoms, radiologic findings, and microbiologic results. Despite an approach of planned reoperation for wound care, the open group had fewer mean procedures performed per patient (1.6 ± 0.7 versus 1.9 ± 1.6), owing to fewer unplanned procedures (0 versus 0.8 procedures/patient) than the flap group. The incidence of wound complications (hematoma, seroma) was lower in open patients (0 of 10 versus 5 of 10). The median length of hospitalization was shorter in the open group (5.5 versus 10.5 days), but all open patients (10 of 10; 100%) required prolonged wound care compared with 2 of 10 (20%) in the flap group. The only hospital mortality occurred in the flap group. Eventual wound healing was satisfactory in all survivors. Conclusions For sternoclavicular joint infection, a single-stage resection and muscle advancement flap leads to a higher incidence of complications. Debridement with open wound care provides satisfactory outcomes with minimal perioperative complications but requires prolonged wound care.
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U2 - 10.1016/j.athoracsur.2010.07.112
DO - 10.1016/j.athoracsur.2010.07.112
M3 - Article
C2 - 21172525
AN - SCOPUS:78650503050
SN - 0003-4975
VL - 91
SP - 257
EP - 261
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -