الفهرس 
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Abstract
This study was conducted at the departments of cardiothoracic surgery in Assiut and Minia university hospitals, between July 2016 and June 2019. All patients completed the follow-up period of 3 months after CABG surgery.
The study included 300 patients with coronary artery disease underwent isolated on-pump CABG surgery at the authors’ institutions. group I included patients with pedicled LIMA (case group; n=200), and group II included patients with skeletonized LIMA (control group; n=100).
The study excluded patients with concomitant cardiac surgery, previous adult cardiac surgery, hepatic failure, renal failure on dialysis, emergency surgery, total arterial revascularization, concomitant carotid artery surgery, minimally invasive direct CABG ”MIDCAB”, off-pump CABG, overt peripheral vascular disease, preoperative critical state: on mechanical ventilation, cardiogenic shock, use of intra-aortic balloon pump ”IABP”, ventricular tachycardia, fibrillation or aborted sudden death.
The study was conducted in accordance with the Helsinki Declaration. An approval from a research ethics committee and informed consents from patients were obtained.
Routine preoperative laboratory and radiological investigations for cardiac surgery were performed for all patients including coronary angiographic and echocardiographic studies. Pre-operative hygienic anti-infection measures were performed. The patients were followed up at outpatient clinics, at intervals of 2 weeks, 6 weeks, and 3 months after surgery.
The primary end point in our study was SWI within 3 months after CABG surgery. Accordingly, all of the patients were evaluated for SWI by assessing sternal instability, local signs of infection, temperature, microbiological study (when there was a wound discharge), plain chest radiograph or chest CT (if SWI was suspected and clinical examination alone cannot confirm the diagnosis).
SWIs were identified in 11.7% (35 patients), 15.5% (31 patients) of them were present in patients who had pedicled LIMA (group I), while 4% (4 patients) of the patients who had skeletonized LIMA (group II) suffered from SWI, with significant difference between the 2 groups.
The types of SWI were: type 1 a (superficial; skin and subcutaneous) in 17 patients (5.66%), type 1 b (superficial; exposure of deep fascia, intact sutures) in 8 patients (2.66%), type 2 a (deep; bone exposure, sternum with stable wire) in 5 patients (1.66%), type 2 b (deep; bone exposure, sternum with unstable wire) in one patients (0.3%), type 3 a (deep; necrotic bone / heart exposure, unstable wire) in 2 patients (0.7%), and type 3 b (deep; type 2 or 3 with septicemia) in one patient (0.3%). There was non-significant difference in the types of SWI between both groups.
There were non-significant differences between the both groups in postoperative complications in terms of postoperative duration of ventilation, hospital stay, blood transfusion, arrhythmias, reoperation for bleeding or tamponade, pulmonary complications.
The significant predictors of SWI in all of the studied CABG patients were pedicled ITA, obesity, diabetes mellitus, excessive bone wax, and excessive diathermy. While, the independent risk factors for SWI in CABG patients with pedicled LIMA (group I) were obesity, diabetes mellitus, and excessive diathermy.
This study was conducted at the departments of cardiothoracic surgery in Assiut and Minia university hospitals, between July 2016 and June 2019. All patients completed the follow-up period of 3 months after CABG surgery.
The study included 300 patients with coronary artery disease underwent isolated on-pump CABG surgery at the authors’ institutions. group I included patients with pedicled LIMA (case group; n=200), and group II included patients with skeletonized LIMA (control group; n=100).
The study excluded patients with concomitant cardiac surgery, previous adult cardiac surgery, hepatic failure, renal failure on dialysis, emergency surgery, total arterial revascularization, concomitant carotid artery surgery, minimally invasive direct CABG ”MIDCAB”, off-pump CABG, overt peripheral vascular disease, preoperative critical state: on mechanical ventilation, cardiogenic shock, use of intra-aortic balloon pump ”IABP”, ventricular tachycardia, fibrillation or aborted sudden death.
The study was conducted in accordance with the Helsinki Declaration. An approval from a research ethics committee and informed consents from patients were obtained.
Routine preoperative laboratory and radiological investigations for cardiac surgery were performed for all patients including coronary angiographic and echocardiographic studies. Pre-operative hygienic anti-infection measures were performed. The patients were followed up at outpatient clinics, at intervals of 2 weeks, 6 weeks, and 3 months after surgery.
The primary end point in our study was SWI within 3 months after CABG surgery. Accordingly, all of the patients were evaluated for SWI by assessing sternal instability, local signs of infection, temperature, microbiological study (when there was a wound discharge), plain chest radiograph or chest CT (if SWI was suspected and clinical examination alone cannot confirm the diagnosis).
SWIs were identified in 11.7% (35 patients), 15.5% (31 patients) of them were present in patients who had pedicled LIMA (group I), while 4% (4 patients) of the patients who had skeletonized LIMA (group II) suffered from SWI, with significant difference between the 2 groups.
The types of SWI were: type 1 a (superficial; skin and subcutaneous) in 17 patients (5.66%), type 1 b (superficial; exposure of deep fascia, intact sutures) in 8 patients (2.66%), type 2 a (deep; bone exposure, sternum with stable wire) in 5 patients (1.66%), type 2 b (deep; bone exposure, sternum with unstable wire) in one patients (0.3%), type 3 a (deep; necrotic bone / heart exposure, unstable wire) in 2 patients (0.7%), and type 3 b (deep; type 2 or 3 with septicemia) in one patient (0.3%). There was non-significant difference in the types of SWI between both groups.
There were non-significant differences between the both groups in postoperative complications in terms of postoperative duration of ventilation, hospital stay, blood transfusion, arrhythmias, reoperation for bleeding or tamponade, pulmonary complications.
The significant predictors of SWI in all of the studied CABG patients were pedicled ITA, obesity, diabetes mellitus, excessive bone wax, and excessive diathermy. While, the independent risk factors for SWI in CABG patients with pedicled LIMA (group I) were obesity, diabetes mellitus, and excessive diathermy.