Wound infections are common complications after open heart surgery, both in the sternotomy and vein harvest wound. Fortunately, most of these infections are superficial and respond to minor wound debridement and antibiotics, however, 1-3% of patients develop deep sternal wound infection with mediastinis; an infection that can be fatal. Late infections with sternocutaneous fistulas are encountered less often, but also represent a complex surgical problem. The vein harvest site is the most common site for wound infections after cardiac surgery and these infections result in significant patient morbidity and increases health-care costs.

This evidence-based review covers etiology, risk factors, prevention and treatment of wound infections following open heart surgery with special focus on advances in treatment, especially negative-pressure wound therapy.

Table I . Pathogens identified in patients with deep sternal infections following open heart surgery in Iceland 1997-2004. Modified from ref. 7.

Table II . CDC criteria for the diagnosis of DSWI (Horan et al., 2008).

Fig. 1a. Purulent deep sternal wound infection 2 weeks after open heart surgery.

Fig. 1b. Deep sternotomy wound where the wound has been debrided, but where sternal wires have not yet been removed.

Fig. 1c. Negative pressure wound therapy applied to the deep sternal wound infection shown in fig. 1a.

Figure 2. Chronic sternotomy infection with subcutaneous fistulas to the skin, osteomyelitis and subcutanous abscess). Photo: Arash Mokhtari, Lund University Hospital.

Figure 3. An extensive vein-harvest wound infection. Photo: Anders Jeppsson