Strategies preventing deep sternal wound infection in cardiac surgery review.

Deep sternal wound infection is a feared complication of cardiac surgery due to the negative impact on mortality, morbidity and long-term survival. Its incidence has remained more or less unchanged over the last three decades despite the significant increase in patients´ morbidity and complexity of cardiac surgery. The review summaries strategies to reduce the incidence of deep sternal wound reflecting general surgical site infection prevention and specificities of surgery performed through the median sternotomy. Furthermore, contemporary evidence-based recommendations for prevention of this complication are highlighted in the review. Key words: sternal infection - prevention - cardiac surgery.

Complex gunshot injury to the heart as a consequence of suicide attempt in a schizophrenic patient.

INTRODUCTION: Self-inflicted gunshot injury to the heart is uncommon in Western Europe countries. However it is considered to have a high mortality through cardiac tamponade or exsanguination and concomitant chest or abdominal cavity injury. CASE PRESENTATION: We present a 39-year-old schizophrenic woman who attempted suicide with the aid of a 6.35mm caliber handgun, after self-discontinuing of antipsychotic treatment. Lower third of sternum, right heart atrium and ventricle and inferior caval vein were hit by the bullet which consequently got lodged in the right paravertebral muscle mass at the lower thoracic vertebral level. As she was hemodynamically unstable due to hemopericardium and a huge right hemothorax, she underwent emergent surgery. Heart and inferior vena caval injuries were repaired on extracorporeal circulation. The postoperative course was uneventful and she was transferred to a psychiatric facility on the 7th postoperative day. One year after the surgery she is well, compliant to antipsychotic medications and on periodic follow-up by psychiatrists. CONCLUSION: This case represents management of complex self-inflicted gunshot cardiac injury in a schizophrenic patient who discontinued antipsychotic medication. Liaison between themedical rescue service and high level trauma center essentially reduced injury-to-surgery time. Complex heart injury was successfully repaired on extracorporeal circulation.