Original article
General thoracic
Sternoclavicular Joint Infection: A Comparison of Two Surgical Approaches

https://doi.org/10.1016/j.athoracsur.2010.07.112Get rights and content

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.

Section snippets

Data Acquisition

We queried a prospectively maintained institutional cardiothoracic surgical database with the following key phrases: sternoclavicular infection, sternoclavicular septic arthritis, clavicular infection/osteomyelitis. All the cases were from a single institution. The study was reviewed by the institutional review board and exempted. Patient records from 2002 through 2009 were reviewed. Case records were individually reviewed, and only patients with SCJ septic arthritis were included. Patients who

Results

Twenty patients (10 women, 10 men) with a mean age of 56.5 years underwent a total of 35 operations for SCJI from 2002 to 2009. Pain (17 of 20 patients; 85%) and swelling (19 of 20 patients; 95%) were the main presenting symptoms. A minority of patients (7 of 20 patients; 35%) had documented fever before admission. Two of twenty (10%) patients were taking immunosuppressive medications, and another 7 of 20 patients (35%) were diabetic. Thirteen of twenty patients (65%) had a discernible focus of

Comment

The true incidence of SCJI is not known, but it is likely to be low, as reported in a review published in 2004 summarizing a total of 180 cases in the literature [1]. Similarly, the fraction of patients requiring an operation for SCJI is unclear. In the review by Ross and Shamsuddin [1], 102 of 174 patients (58%) underwent an operation, but this is likely to be an overestimate when applied to the general population as it is more likely that patients undergoing an operation are reported in the

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