Effect Of Skeletonization Of Internal Mammary On The Incidence Of Deep Sternal Wound Infection And Post Operative Pain In Patients Undergoing Coronary Artery Bypass Grafting
Keywords:
Skeletonization, LIMA, CABGAbstract
Background: Coronary revascularization has advanced significantly since Coronary Artery Bypass Grafting (CABG) was introduced over fifty years ago, remaining the gold standard for coronary artery disease (CAD), particularly in diabetics or multivessel disease cases.
Aim: To compare the early outcome of left skeletonized mammary harvesting and pedicled left mammary harvesting in cases having CABG operation.
Patients and methods: In this non-randomized prospective clinical trial, data of 230 cases with ischemic heart disease requiring CABG who were admitted to Kasr Al-Ainy Hospitals and other affiliated hospitals, in the duration from February 2023 to August 2024, categorized into to 2 groups: Group (A): 115 cases of CABG operation with skeletonized left internal mammary artery (LIMA) harvesting. Group (B):115 cases of CABG operation with pedicled LIMA harvesting.
Result: Pain levels, measured by Visual Analog Scale (VAS) score, were significantly reduced in the skeletonized group than the pedicled group (2.08±0.48 versus. 2.97±0.36; P<0.001). Postoperative paresthesia was also less frequent in the skeletonized group (12.2% versus. 22.6%; P=0.037). Nevertheless, insignificant differences have been observed in deep sternal wound infection (2.6% versus 4.3%; P=0.722) or sternal dehiscence (2.9% versus 1.7%; P=1). ICU and hospital stay durations were similar between groups, with mean ICU stays of 2.09±0.39 and 2.18±0.59 days, and hospital stays of 6.19±0.85 and 6.32±1.06 days, respectively.
Conclusion: LIMA harvesting reduced postoperative pain, blood drainage, and paresthesia compared to the pedicled technique, enabling more anastomoses. No differences were found in wound infection, sternal dehiscence, ICU stay, or hospitalization duration.
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