Early and Mid-Term Outcomes of Quadruple Attack Technique for Sternal Osteomyelitis and Chronic Sinus Formation After Cardiac Surgery

Ahmed Ahmed; Ahmed T Sayed; Khaled Refat; Ahmed Toema

Ahmed Ahmed Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Ahmed T Sayed Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Khaled Refat Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Ahmed Toema Department of Cardiothoracic Surgery, Faculty of Medicine, Helwan University, Egypt

Keywords: Sternal osteomyelitis, Sternal sinus, Cardiac Surgery

Abstract

Background: Sternal osteomyelitis with chronic sinus tract after cardiac surgery is a serious complication, and early management is crucial. The aim of this study is to report our experience with the “Quadruple Attack” technique, which involves intravenous (IV) antibiotics, surgical debridement, vacuum therapy, and hyperbaric oxygen sessions for management of this condition.

Methods: This prospective study was performed at Cardiothoracic Surgery Department, Ain Shams University in Egypt between March 2020 and August 2024 and included 52 patients who underwent the quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract.

Results: The mean age was 49.6 ± 9.23 years. 12 (23.1%) patients were hypertensive, while 17 (32.7%) of patients had diabetes. 44 (84.6%) of patients had satisfactory healing, 8 patients (15.4%) had re-sternotomy and resection of the sinus tract, while 5 patients (9.6%) required sternectomy and musculocutaneous flaps.

Conclusion: Our quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract after cardiac surgery is promising, with encouraging mid-term outcomes in selected patients with a non-dehisced sternum.