Effect of topical Vancomycin on consolidation of sternum surgical fracture in open-heart surgery

Document Type : Original Article


Cardiologist, Cardiovascular Department. National Medical Center “20 de Noviembre” ISSSTE, México City, México.


Introduction: The physiological process of sternum surgical fracture consolidation in patients undergoing cardiac surgery could be prolonged by the invasion of gram-positive saprophytic bacteria which perpetuates the local inflammatory process despite the standardized aseptic and antiseptic measures in cardiac surgery. In this regard, the topical application of Vancomycin can exert a positive effect and prevent the perpetuation of the local inflammatory process by the elimination of these bacteria which in turn reduces bone consolidation time.The purpose of the current study was to determine the effect of topical Vancomycin on sternum surgical fracture consolidation in patients undergoing to open-heart surgery.
Materials and Methods: Patients who underwent open heart surgery were assigned into groups receiving the topical application of bone wax or Vancomycin mass in the spongy tissue exposed by surgical sternotomy, prior to sternal closure. The bone consolidation processes were assessed by two expert radiologists with simple chest computed tomography (CT) in the postoperative period (4, 8, and 12 weeks).
Results: The study was conducted on 55 patients in Vancomycin (n=33) and bone wax group (n=19). The computerized axial tomography (CAT) scan revealed a higher number of patients with early bone consolidation (Medullar and bone continuity, and callus bone) in Vancomycin group, as compared to bone wax group (p values between 0.004-0.02 at 4 weeks and 0.01-0.06 at 8 weeks). However, no difference was observed at 12 weeks (P=0.09-0.11). Moreover, The magnitude effect of topical Vancomycin was high (>90%) at 3, 8, and 12 weeks of follow up, compared to the patients who received bone wax (<90%).
Conclusion: The topical Vancomycin application had a positive effect on sternal surgical fracture and promotes an early bone consolidation in patients undergoing open-heart surgery.


  1. Puga FJ. La cirugía convencional sigue siendo la mejor opción en el tratamiento quirúrgico de la valvulopatía aórtica. Argumentos a favor. Rev Esp Cardiol. 2000; 53:479-82.
  2. Tsiridis E, Upadhyay M, Giannoudis P. Molecular aspects of fracture healing: which are the important molecules. Injury. 2007; 38: S11-25.
  3. De Feo M, Gregorio R, Della Corte A, Marra C, Amarelli C, Renzulli A, et al. Deep sternal wound infection: the role of early debridement surgery. Eur J Cardiothorac Surg. 2001; 19:811-6.
  4. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001; 20:1168-75.
  5. Braxton JH, Marrin CA, McGrath PD, Morton JR, Norotsky M, Charlesworth DC, et al. 10-year follow-up of patients with and without mediastinitis. Sem Thorac Cardiovasc Surg. 2004; 16:70-6.
  6. Pezzella T. Mediastinitis following open heart surgery: introduction. Sem Thorac Cardiovasc Surg. 2004; 16:51-2.
  7. Friberg O, Svedjeholm R, Soderquist B, Granfeldt H, Vikerfors T, Källman J. Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized controlled trial. Ann Thorac Surg. 2005; 79:153-61.
  8. Cohen J. Statistical power analysis for the behavioral sciences. Second editionPsychology Press Taylor & Francis Group; 2009
  9. Lilly E, Company, Ltd. Manufacturers of vancomycin hydrochloride as brand name vaccine. Basingstoke: Hampshire RG21 6XA; 2002.
  10. Hafermann MJ, Kiser TH, Lyda C, Fish DN, Barber GR, Wempe MF, et al. Weight-based versus set dosing of vancomycin for coronary artery bypass grafting or aortic valve surgery. J Thorac Cardiovasc Surg. 2014; 147:1925-30.
  11. Pezzella T. Mediastinitis following open heart surgery. Sem Thorac Cardiovasc Surg. 2004; 16:51-2.
  12. Veitch SW, Findlay FC, Hamer AJ, Blumsohn A, Eastell R, Ingle BM. Changes in bone mass and bone turnover following tibial shaft fracture. Osteoporos Int. 2006; 17:364-72.
  13. Wildemann B, Schmidmaier G, Ordel S, Stange R, Haas NP, Raschke M. Cell proliferation and differentiation during fracture healing are influenced by locally applied IGF-I and TGF-beta1: comparison of two proliferation markers, PCNA and BrdU. J Biomed Mater Res B Appl Biomater. 2003; 65:150-6.
  14. Schmidmaier G, Wildemann G, Heegere J, Gäbelein T, Flyvbjerg A, Bail HJ, et al. Improvement of fracture healing by systemic administration of growth hormone and local application of insulin-like growth factor-1 and transforming growth factor-𝛽1. Bone. 2002; 31:165-72.
  15. Moghaddam A, Muller M, Roth HJ, Wentzensen A, Grutzner A, Zimmermann G. TRACP 5b and CTX as osteological marker soft delayed fracture healing. Injury. 2011; 42:758-64.
  16. Zimmermann G, Henle P, Kusswetter M, Moghaddam A, Wentzensen A, Richter W, et al. TGF-𝛽1 as a marker of delayed fracture healing. Bone. 2006; 38:456-7.
  17. Sarahrudi K, Thomas A, Mousavi M, Kaiser G, Köttstorfer J, Kecht M, et al. Elevated transforming growth factor-beta1(TGF-𝛽1) levels in human fracture healing. Injury. 2011; 42:833-7.
  18. Stoffel K, Engler LH, Kuster M, Riesen W. Changes in biochemical markers after lower limb fractures. Clin Chem. 2007; 53:131-4.
  19. Kurdy NM. Serology of abnormal fracture healing: The role of PIIINP, PICP, and BsALP. J Orthop Trauma. 2000; 14:48-3.
  20. Seibel MJ. Biochemical markers of bone turnover. Part II: clinical applications in the management of osteoporosis. Clin Biochem Rev. 2006; 27:123-38.