Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation☆
Bibliographic record
Abstract
OBJECTIVE: To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. METHODS: Between 2002 and 2007, 10665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients. RESULTS: Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p=0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p<0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal. CONCLUSIONS: To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".