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Supportive treatment using a compression garment vest of painful sternal instability following deep surgical wound infection: a case report
© Klement and Herrmann; licensee BioMed Central Ltd. 2010
Received: 22 September 2009
Accepted: 11 August 2010
Published: 11 August 2010
Sternal dehiscence and instability poses a significant cause of persistent pain and limited quality of life following hospital discharge for 0.2% to 5% of patients who have undergone median sternotomy for open heart surgery. We report a successful, conservative, supportive long-term therapy of painful sternal non-union using a customized compression garment vest.
We report a case of painful sternal instability following open heart surgery in a 74-year-old Caucasian man. The complicating factors of obesity (body mass index of 40), renal failure, insulin-dependent diabetes mellitus and absolute arrhythmia with atrial fibrillation were present.
A number of studies have demonstrated the efficacy of surgical interventions for secondary sternal stabilization, but individual patients may reject this option or may be, for other reasons, no longer operable. The task of primary care physicians and other health care providers is to offer this group of patients an alternative option for pragmatic, inexpensive and effective supportive therapy, of which compression garments are an example.
Deep surgical wound infections (DSWIs) after coronary artery bypass grafting (CABG) are known to be rare but serious complications. Sternal dehiscence occurs in 0.2% to 5% of patients who have undergone median sternotomy, and poses a significant cause of persistent pain and limited quality of life following hospital discharge . Although diverse studies have demonstrated the efficacy of surgical interventions for secondary sternal stabilization, individual patients reject this option or are for other reasons no longer operable . The task of primary care clinicians is to offer this group of patients an alternative option for pragmatic and cost-effective conservative therapy.
Devices for external compression of the thorax to prevent or treat sternal instabilities have been systematically investigated in only a few studies, but have shown promising results . Relatively rigid 'corset-like' constructions can, as we have occasionally observed, easily slip out of place, particularly on patients who are obese, and cause skin irritations at the edges of the material due to bulging skin. An alternative is offered by compression garments: they are available worldwide from different manufacturers and in a variety of materials, are relatively inexpensive, and suitable for practical daily use due to their elasticity. In a pilot study involving 15 patients, they were found to be not significantly inferior to rigid 'adjustable fastening braces' in their adaptive effects on sternal wound edges. Long-term comparisons of safety and efficacy in larger study populations have not yet been conducted . To the best of our knowledge, there has been no report to date on conservative supportive long-term therapy of painful sternal non-union using compression garments.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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