Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy.

BACKGROUND: Retrospective studies concerning the operative preservation and nonoperative management of splenic injuries in patients with splenic trauma have been published; however, few studies have analyzed prospectively the results and early complication rates of a defined management in splenic injury. METHODS: From 1986 to 2006, adult patients with blunt splenic injuries were evaluated prospectively with the intent of splenic preservation. Hemodynamically unstable patients underwent laparotomy. Stable patients were treated conservatively regardless of the grade of splenic injury determined by ultrasound and/or CT scan. RESULTS: During a 20-year period, 155 patients were prospectively evaluated. In 98 patients (63%), the spleen could be preserved by nonoperative (64 patients, 65%) or operative (34 patients, 35%) treatment and 57 patients (37%) needed splenectomy. There were no differences in age, sex, or trauma score between the groups, but a higher early infection rate in patients with splenectomy compared with patients with splenic preservation (p < 0.005) was observed, even if the patients were matched with respect to multiple trauma using the Injury Severity Score (p < 0.01). CONCLUSIONS: Splenic preservation in patients with blunt splenic injury by operative or nonoperative treatment leads to lower early infection rates in adults and, therefore, should be advocated.

New transverse plate fixation system for complicated sternal wound infection after median sternotomy.

Wire fixation after median sternotomy is a safe procedure, but it is still associated with potential wound infection including bony dehiscence. In case of infection and dehiscence the sternum is re-fixated with steel wires. If this is insufficient, then flap reconstruction would be another option. We describe an alternative way for complicated sternal closure by using a rigid sternal fixation system that is feasible for cardiac surgeons. Three patients suffering from sternal instability and infection were operated on with the new titanium plates. The procedures were uneventful and short-term follow-up showed stable sternal conditions. In this report the technical concept has been described in detail in 1 patient. This new sternal fixation technique is safe and easy to handle and broadens the spectrum for closure of complicated sternal wound infections or dehiscence.