Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting

• Incidence of DSWI following BIMA harvest is on decline.
• Optimization of risk factors prior to BIMA harvest reduce DSWI.
• IMA harvest technique with minimal tissue mobilization preserves sternal blood supply.
• Stable sternal closure is associated with reduction of DSWI.
• Combination of reported strategies brings down DSWI to a minimum.

Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. Several risk factors have been identified with sternal wound infections and a few are modifiable. Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article.