Sternoclavicular joint infection: A comparison of two surgical approaches

Varun Puri, Bryan F. Meyers, Daniel Kreisel, G. Alexander Patterson, Traves D. Crabtree, Richard J Battafarano, Alexander S. Krupnick

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)257-261
Number of pages5
JournalAnnals of Thoracic Surgery
Volume91
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

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Sternoclavicular Joint
Wounds and Injuries
Debridement
Infection
Manubrium
Clavicle
Ribs
Seroma
Incidence
Hospital Mortality
Reoperation
Hematoma
Wound Healing
Survivors
Comorbidity
Hospitalization
Joints
Muscles

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Puri, V., Meyers, B. F., Kreisel, D., Patterson, G. A., Crabtree, T. D., Battafarano, R. J., & Krupnick, A. S. (2011). Sternoclavicular joint infection: A comparison of two surgical approaches. Annals of Thoracic Surgery, 91(1), 257-261. https://doi.org/10.1016/j.athoracsur.2010.07.112

Sternoclavicular joint infection : A comparison of two surgical approaches. / Puri, Varun; Meyers, Bryan F.; Kreisel, Daniel; Patterson, G. Alexander; Crabtree, Traves D.; Battafarano, Richard J; Krupnick, Alexander S.

In: Annals of Thoracic Surgery, Vol. 91, No. 1, 01.2011, p. 257-261.

Research output: Contribution to journalArticle

Puri, V, Meyers, BF, Kreisel, D, Patterson, GA, Crabtree, TD, Battafarano, RJ & Krupnick, AS 2011, 'Sternoclavicular joint infection: A comparison of two surgical approaches', Annals of Thoracic Surgery, vol. 91, no. 1, pp. 257-261. https://doi.org/10.1016/j.athoracsur.2010.07.112
Puri, Varun ; Meyers, Bryan F. ; Kreisel, Daniel ; Patterson, G. Alexander ; Crabtree, Traves D. ; Battafarano, Richard J ; Krupnick, Alexander S. / Sternoclavicular joint infection : A comparison of two surgical approaches. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 1. pp. 257-261.
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abstract = "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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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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