Qualiteam s.r.l. Products To Advance Recovery

Qualiteam develops, manufactures and distributes unique products gentle to the human body with focus on patient comfort and functional convenience for staff. (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','//www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-44061039-2', 'tumblr.com'); ga('send', 'pageview');

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#NTI2015 in San Diego

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Why hospitals should definitely consider an external chest support for open heart surgery patients

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Coughing, sneezing, moving and respiratory therapy after #openheartsurgery is a lot easier with the help of #QualiBreath to speed up recovery #cvor #sternotomy

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Why #openheartsurgery patients need an external chest support after surgery http://j.mp/1xVCZvK

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Read here why postoperative heart pillows may do more harm than good: http://j.mp/1DjW3Kq #openheartsurgery #chd #awareness #heart #pillow

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A burst appendix and a QualiBelly abdominal support

Our Canadian distributor recently sent a QualiBelly abdominal support to one of his collaborators rather than flowers. She had just been through emergency surgery for a burst appendix.

The day after she received the QualiBelly she sent an email to our distributor and the response that came back to him was great feedback for this product and we just had to share it.

Here is what she had to say:

“Don't know how to thank u. Why are all hospitals not giving this to their patients with incisions. I was finally able to get out of bed in less than two minutes as opposed to ten and didn't have to find a way to hold my stomach with a pillow and try to maneuver myself up without falling out of bed all at the same time. This should be made mandatory :):):). Thank u. I owe u one and so does the rest of my family who didn't have to listen to me groan endlessly. “

C. G. Oakville, Canada.

  Next time you hear about someone getting abdominal surgery send them a QualiBelly or QualiBelly Advanced instead of or together with flowers to help them recover faster and get out of the hospital sooner. 

Here are 10 reasons every abdominal surgery patient should use QualiBelly Advanced. 

Did you just have or are going to have abdominal surgery ? Find out here why wound compression is so important.

  Have you had any experience with postoperative external supports?  Leave a comment below, we would love to hear what you think.

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Do you need or just had abdominal surgery ?

Did you know that healing of a wound involves 4 phases in the recovery process?

Hemostasis (clotting of blood) starts immediately.

Inflammation (swelling, redness) begins on day 1 and lasts usually to day 4. Causes warmth and pain.

Proliferation (reconstruction of tissue) happens from day 4 to about day 21. Causes contraction and a grainy surface.

Remodeling (maturation) takes place from day 21. It may take 1-2 years before the full strength of tissues and muscles have been regained.

Being familiar with the process of wound healing helps to understand what YOU can do to protect your wound and achieve a healthier, less painful and more speedy recovery without complications. Not only in the hospital, but at home too.

QualiBelly Advanced will help you to support your wound and abdominal muscles, and the QualiPad seat belt pad will protect your wound from any irritation or pressure caused by car seat belts. Learn more about the Postoperative Care Kit here.

Why is wound compression important?

It helps to control swelling in the inflammation period after surgery which reduces incision pain. Compression also counteracts the sudden high rise in internal pressure during coughing, because your muscles are supported. This will cause less pain and protect your wound. And compression is important for prevention of potential complications after surgery, like hernia, wound dehiscence and infections.

QualiBelly Advanced is a unique compression support for any kind of surgery in the abdominal area and has unmatched comfort and functionality, both for you and your health care staff. 10 reasons every abdominal surgery patient should use QualiBelly Advanced

How QualiBelly Advanced helps you:

QualiBelly Advanced is light years ahead of traditional abdominal binders, both in comfort for patients, functionality and convenience for staff.

QualiBelly Advanced starts a chain reaction to advance your recovery and get you home sooner:

CONSTANT PROTECTION AND SUPPORT: First, your wound and abdominal area will constantly be protected by the elastic, firm, ventilated and remarkably light material. The level of compression can be adjusted to the type of surgery you have had, and to what you feel is comfortable on your upper-, mid- and lower part of the abdomen. Such compression leads to less swelling and less pain, which gives you more comfort and a better posture. And you don’t need to support your wound with your hands which leaves them free for other tasks.

IMPROVED POSTURE AND DEEPER BREATHING: Your improved posture makes you stand and walk more upright, which helps you to be able to perform a more profound and less painful breathing.  Deeper breathing is not only crucial after surgery to avoid lung complications, it is also an important stress reliever. With less pain, a better posture, improved breathing and your hands free, it is easier to get out of bed, walk and do the exercises that hospital staff will recommend for you to get up to speed again after surgery.

YOU GET IN CONTROL OF YOUR RECOVERY: You are less dependent on health care staff since drainage systems or other devices are attached directly to you on the QualiBelly Advanced. When you want to get out of bed, you do not have to wait for available staff. You gain more control of your exercise activities and progress of recovery. And when you want to sit down and rest, just fold the upper band down. Then there is no pressure on your upper abdomen, you breathe easier and get more back support.

  Conclusion:

QualiBelly Advanced is an important key to advance recovery, well-being, hospital experience and to prevent postoperative complications which ultimately decrease health care costs. Have you had any experience with QualiBelly Advanced or other abdominal compression supports ? Leave a comment below! We would like to hear your opinion.

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10 reasons abdominal surgery patients should use QualiBelly Advanced

QualiBelly Advanced is light years ahead from being a traditional abdominal binder.                                                                                                                                It is a unique tri-band incision support for critical interventions in the abdominal area. That means any larger surgery on internal organs like liver, spleen, pancreas, stomach, large and small intestines, kidneys, uterus, ovaries, prostate gland, bladder and the vascular system in the abdominal region. QualiBelly Advanced is furthermore for all abdominal hernia surgeries, abdominal plastic reconstructive and bariatric surgery. It is designed to do all the following after larger interventions in the abdominal area: prevent infection, decrease pulmonary complications, lessen pain, enhance comfort, improve posture, improve breathing and stimulate activity.

How can an external incision support like QualiBelly Advanced do all this? It is all possible thanks to the proprietary design. Here are the 10 key reasons that explain how patients, healthcare staff and hospital administrators can benefit from using QualiBelly Advanced:

Decreased risk of infection Separation of drainage systems, driver line systems or any other device systems is completely eliminated when using QualiBelly Advanced - the risk of infection is decreased

No more time-consuming cutting of holes in binder material The bands of the QualiBelly Advanced are closed above and below drainage tubes, stoma devices, driver lines or other devices that may exit from the abdominal area, and the closure slits give ample space and flexibility for any size or form of devices - the use of scissors or knives to make holes in the material is completely eliminated

Wound inspection and care with maintained abdominal support and less pain One or two of the three QualiBelly Advanced bands can be opened for free access to the wound site, while one (or two) of the bands remain closed - partial abdominal support is maintained making wound care less painful

Reclosure by just one healthcare person Unlike traditional binders, QualiBelly Advanced can easily be re-closed on patients of all body sizes incl. on the extremely obese, on condition that one of the bands is kept closed - less staff required to handle wound care

Compression adjusted to type of surgery The compression can be individually adjusted at upper, mid or lower abdominal segments thanks to the three bands being attached to each other by a proprietary stitching method while leaving ample closure slits - unmatched patient comfort

Conversion to a lower two-band support Unlike traditional binders the top band of QualiBelly Advanced can easily be folded down for additional comfort and back support when patients need a rest in the sitting position - unmatched patient comfort 

Optional universal drainage/device holder and line organiser Enables organisation and attachment directly to the QualiBelly Advanced of drainage bottles or other devices and their respective lines which facilitates the patients liberation from the bed - no more need for pins or tape

Compliments and protects the internal closures with a firm, external support Reduces swelling and potential for hernia, optimizes wound alignment and healing - decreased risk of complications

Improves patients posture and breathing techniques A better posture improves a patients breathing which helps to prevent postoperative lung complications - decreased risk of complications

Decreases health care costs and gives a hospital significant return of investment Designed to prevent infections, decrease postoperative pain and pulmonary complications - significant ROI

Incision pain can be relieved by pain medication. It does not improve a poor posture or a shallow breathing, nor does it stimulate mobilisation or prevent postoperative complications. QualiBelly Advanced is an important key to advance recovery, well-being, hospital experience and to prevent postoperative complications which ultimately decrease health care costs.

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10 key reasons sternotomy patients should use QualiBreath

QualiBreath is the ideal product for patients who have had a sternotomy or other interventions in the chest. It is a chest surrounding sternum support with integrated handles for increased support available in all sizes for adults, pediatric and infant patients. Heart surgery and other operations in the chest cause soreness in the first days after the operation therefore patients may be reluctant to breathe deeply and to cough - to avoid the discomfort of pain. Yet deep breathing, coughing and early return to normal movement are very important for the patients quick and complication-free recovery. Here are 10 key reasons why sternotomy patients should use QualiBreath:

Dual-functional external chest support Constant lateral support on the sternum and patient-activated reinforcement handles during coughing, sneezing, pain.

Documented positive effect on patient’s entire recovery process Improves sternal stability, pain relief, ease of breathing, comfort, patient function, ease of activities and exercise.

Decreases deep sternal wound infections Documented effect of a firm, constant external support on the chest and sternum.

Keeps the lower lung lobes and the upper abdominal area free Secures unrestricted deep respiration and increased comfort.

Supports the respiratory muscles and relieves pain The firm, elastic material encourages deep breathing and coughing to clear the lungs of atelectasis and secretions.

Compliments the internal closure from the outside Increases the potential for an optimal sternal alignment.

Unmatched comfort Adjustable tension with the ability to loosen or tighten to near rigid state which increases compliance with usage in the hospital and at home.

Important adjunctive recovery treatment Constant “reminder” to the patient that encourages mobilization and exercise of the upper limbs which increases blood supply and stimulates healing of the fractured sternum.

Important psychological aid to put the patient in control of his own recovery Helps the patient to handle responsibility for sternum protection and wound care after discharge.

Decreases health care costs and gives a hospital significant return of investment Prevents sternal infections, decreases postoperative pain and pulmonary complications.

References: All literature references are summarized, described and listed in the white paper titled: “Evaluation of external chest supports based on the entire recovery process in and out of the hospital to avoid offset costs of long term complications and medications” and available  on www.qualiteam.com

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Qualiteam exhibits at AATS 2014 in Toronto, Canada

It is with great pleasure that we are exhibiting once again at the upcoming American Association for Thoracic Surgery (AATS) annual meeting from April 26 to 30 at the Metro Toronto Convention Centre in Toronto, ON, Canada, where some of the best science in this specialty will be presented.

We will have a gorgeous new booth where we'll show our main products for cardiac and thoracic surgery QualiBreath - Sternum and thorax support, QualiBra Advanced - Breast and sternum support, their accessories, and our other product lines.

Here is a sneak preview of our products in the booth: QualiBreath on the left, QualiBra Advanced on the right and in the middle a video showing the use of QualiBreath.

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Did you know QualiBreath also helps recovery after rib fractures ?

If you thought QualiBreath is only for sternotomy patients, read this:

The QualiBreath sternum and thorax support is developed to compliment the internal sternum closure from the external side, and to assist with the issues sternotomy patients are faced with after surgery such as difficulties with breathing, coughing and coping with pain.

One of the keys to the efficiency of QualiBreath is the precisely defined elastic material which gives a firm, yet comfortable, constant support to the respiratory muscles and the total thoracic cage. Such support is crucial when breathing hurts, as it does after a sternotomy, - OR after ribs are broken!

Last week we received a mail from a friend that had broken several ribs after an accident and needed some type of support. We chose the QualiBreath for him because of it’s firm, constant, elastic support to the respiratory muscles and the chest, and because it has the option of additional support when using the bar-handles during coughing. We are very pleased that we could help him get relief. See what he said about QualiBreath in a letter:

“Doris, I did a stupid thing Monday last week, and fell out of a tree from which I was removing branches. It was a 5 meter drop. So I have a few broken ribs and a fracture through the tibial plateau. For what I did, I got amazingly minor damage, and there is nothing to do but wait while the fractures heal (and avoid load bearing on the leg). But the most painful thing is the rib fractures especially when I try the deep breathing they wanted me to do to maintain lung function. So I thought of you and QualiBreath..... I confess I was somewhat skeptical about the ability of support garment to limit pain, but it really does. It's not an exaggeration to say I am amazed! So I am really impressed with what you have achieved in the QualiBreath, and wish you all the best with it.... Best Wishes, Bill"

This is not the first experience we have with QualiBreath being an efficient pain reliever for patients with broken ribs. We have many reports of this and a testimony from another one of our friends personal experience published on our web site. Thoracic surgeons, staff in emergency clinics and other health care departments dealing with rib fractures must know what QualiBreath can do for their patients. QualiBreath is an important adjunctive tool for any condition where breathing hurts.

QualiBreath is not just for patients who have had a sternotomy. Patients with rib fractures need it too!

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20 facts you may not know about recovering from heart surgery and the use of external chest supports

Here are 20 facts that you may or may not know about postoperative recovery after heart surgery and the complications that may arise. These points are extracted from the recently published White Paper from D. Hjorth titled: "Evaluation of external chest supports based on the entire recovery process in and out of the hospital to avoid offset costs of long term complications and medications." Read the White Paper and find the related references here.

Surgical techniques continue to improve, yet the rate of complications after a sternotomy procedure are still significant and stable, and cost the health care system enormous sums.

Statistically, in a hospital performing 1000 annual cases, the incidence of deep sternal wound infections averages at 3 patients per month with a cost of +/- $ 65,000 per case. That is an additional cost of +/- $2.3 mill. annually.

More than half of these complications are diagnosed after discharge.

According to statistics a "1000-annual-cases" hospital has more than 400 patients with pulmonary complications which adds $28,000 per case, and over 300 patients with persistent postoperative pain adding costs of $6,000 per case.

There is no clear agreement on guidelines for postoperative care concerning best breathing and upper limb exercises in the hospital or at home, and recommendations vary from hospital to hospital, from country to country, and there is limited control on how strictly patients follow recommendations after discharge.

The soft tissue heals in 4 to 5 weeks, and the sternum bone takes 6 to 8 weeks to heal.

Patients are discharged as early as possible. This shifts the responsibility for recovery and wound care from the hospital staff to the patients themselves, their family or other caretakers.

When the two sternal halves are retracted to opposite sides during the surgery, it will cause considerable strain on the anatomy of the chest, back, shoulders and neck, and result in musculoskeletal and neurological complaints.

Pain causes reluctance to breathe deeply and to cough which impedes a proper lung clearance for atelectasis and secretions. Pain slows down early mobilisation and exercise of the upper limbs which in turn slows down the blood supply to the fractured sternum.

Patients may not receive sufficient pain medication due to their concern for addiction, and staff may not offer pain medication out of standard regimes if patients do not ask.

A successful recovery depends on how clearly patients are instructed, have understood the instructions, and what tools they have available to assist their daily day activities at home.

An external chest support which firmly, comfortably compliments the internal sternal closure, relieves pain and assists respiratory exercises, can only increase the odds for an optimal alignment of the two sternal halves and a complication-free healing of the sternum.

The decision to choose a specific device must be based on how it can improve the patient’s entire recovery process, and how comfortable it is to use in order to secure patient compliance with usage in the hospital and at home for up to 8 weeks.

QualiBreath and QualiBra Advanced are the only dual-functional devices. They give a constant, firm, lateral support on the sternum, and have a patient-activated additional circumferential support for coughing, sneezing and other painful situations.

All other external chest support devices are single-functional, and are either a constant chest compression device, or a patient-activated cough support device.

Single-functional devices with patient-activated cough support have no constant effect on the sternum, pain or respiration, and can only assist with coughing if the patient reacts in time.

Single-functional devices with a constant compression on the chest have no extra means of support for coughing, and must fit extremely tight to counteract the sudden high internal pressure during coughing and/or sneezing, which make these devices extremely uncomfortable and painful to use for the patients.

A firm, constant support on the chest has been shown to decrease deep sternal wound infections in several external chest devices. If such device decreases deep sternal wound infections but has no effect on superficial sternal infections and causes discomfort, pain and restrains activities, the cost savings are most likely to be offset by other complications and long term medications.

QualiBreath is the only device that has been documented to have a positive effect on sternal instability, pain relief, ease of breathing, comfort, patient function, ease of activities and exercise.

QualiBreath and QualiBra Advanced, which incorporates a mini-QualiBreath, are the most comfortable, effective external chest and breast supports available, and are an important adjunctive method to assist the healing sternum, prevent sternal infections, decrease postoperative pain and pulmonary complications, and ultimately decrease health care costs.

When you consider these important facts and that every publication on the clinical use of a variety of external chest supports have revealed significant advantages, it is puzzling why external chest supports are not included routinely in postoperative care to improve recovery, avoid complications and decrease related health care costs.

Let us know your opinion. Leave a comment below.

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Here is why external chest supports really help after heart surgery

In a recently published white paper D. Hjorth, the designer behind all Qualiteam products, evaluates external chest supports based on the entire recovery process, in and out of the hospital, to avoid offsetting costs for health care providers in the form of long term complications and medication.

You can read the complete white paper here.

Abstract:  "In spite of improved surgical techniques, the incidence of complications after sternotomy procedures have been stable during the last decade, and is costing the health care system enormous sums. A significant number of sternal wound complications are discovered after discharge, which has shifted the focus to postoperative care. There is an increased interest in alternative, non-surgical treatments, such as the use of external chest support devices as an adjunctive method to decrease postoperative complications and the related health care costs.

Several external chest support devices have been shown to decrease the incidence of deep sternal wound infections (DSWI) and dehiscence. If an external support device improves sternal stability but causes discomfort, pain or restrains activities, the clinical and cost advantages are most likely offset by long term complications and medications post-discharge, and it is difficult to assure that patients continue to use a device at home until the sternum has healed properly.

The decision to use a specific device must be based on how the patient’s entire recovery process is improved in the hospital and at home, and how sternal wound infections, dehiscence, pain, and pulmonary complications are addressed, including whether there is a positive effect on patient function, comfort, ease of breathing, and ease of exercise activities.

The purpose of this documentation is to review literature on complications following a sternotomy procedure, and evaluate the experience with external chest supports with regards to clinical evidence, cost justification, and essential functions,. The conclusion is that the QualiBreath external chest support presently has the highest potential for improving a patient’s entire recovery in the hospital and at home."

If you are interested in learning more about QualiBreath you can check out the product information page here.

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We treat patients, not diseases. All healthcare flows through the relationships between the healthcare provider and patient. The spoken language is the most important tool in medicine.

Eric Cassell, Talking with Patients, 1985. (via medicalstate)

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Recovery after median sternotomy is often slowed down by too restrictive precautions.

Sternal precautions should be patient specific and focus on patient characteristics and function to improve recovery instead of slowing it down, authors Cahalin LP et al. write in an extensive literature research published in Cardiopulmonary Physical Therapy Journal. (*1.)

The authors review available research related to median sternotomy procedures and the physical activity patients are allowed to do.

No universally accepted definition of sternal precautions exists for patients who have had a sternotomy.

The guide for precautions is usually anecdotal or expert opinion at best supported by indirect evidence. In most cases patients receive the same instructions over a fixed time-frame without regard to individual differences, risk factors for complications or clinical status of the recovery process.

Physical activities, functional tasks and recommended exercise are too restrictive in the immediate postoperative period, the authors write. Such restrictions can hinder an optimal sternal healing. As other muscles are not being exercised, the consequence can be atrophy of the chest wall muscles and weakening of the connective tissue structures.

The authors believe that numerous postoperative symptoms such as constant pain, impaired lung function and chest wall movement can be caused by overly restricting activities. They write that many other clinicians and researchers increasingly share the same view and are questioning whether sternal precautions are too restrictive.

Upper body exercise has a beneficial effect on circulation of blood in the arms and chest wall which promotes healing.

The authors have the opinion that an optimal degree and duration of activity should be based on the patients’ characteristics such as risk factors, comorbidities and previous activity levels etc. They also believe activities should have a progression in stages.

Cahalin et al. present a proposal for a step-by-step procedure with well-defined instructions for patient activity after sternotomy.

The algorithm presents a less restrictive and more individual, dynamic application of sternal precautions.

Patients are divided into risk categories for sternal complications based on known risk factors, clinical evaluation of the wound characteristics and other patient factors. The type and degree of activity precautions is determined according to the risk category for the individual patient. The algorithm allows for progression of activity based on each patient’s recovery characteristics in stead of a sudden lifting of all precautions at a certain time-point.

This publication is a strong support for QualiBreath: QualiBreath is an elastic sternum and thorax support. It can be adjusted to be as firmly supportive on the patient’s chest as desired. Whatever risk category a patient is placed into, QualiBreath can be adapted to fit the patients specific characteristics and needs.

The precisely defined elasticity of the QualiBreath material will support the patient’s thoracic muscles during activities in stead of restricting them.

QualiBreath, referred to as an adjustable fastening brace, is quoted in the publication:  “El-Ansary et al recently investigated the effects of supportive devices in patients with chronic sternal instability and found that use of an adjustable fastening brace [QualiBreath] improved pain and lessened sternal separation”.

The authors conclude: “A precautionary approach rather than restrictive approach is likely to better facilitate optimal sternal healing and functional recovery after a median sternotomy”. Their extensive literature research strongly confirmed that progressive rehabilitation is needed to improve thoracic motion, pulmonary function, symptoms and functional status after sternotomy.

It’s time for change. Sternal precautions must focus on function and patient characteristics to facilitate recovery rather than impede it.

What is your opinion on this ? Leave a comment below.

References: * 1. Sternal Precautions: Is It Time for Change? Precautions versus Restrictions - A Review of Literature and Recommendations for Revision.. Cahalin LP et al. Cardiopulmonary Physical Therapy Journal, Vol 22, No. 1, March 2011 Pg. 5-15

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Pillows. Part of the problem, not the solution!

Many hospitals supply heart patients with pillows, often called heart- chest- or cough- pillows. The purpose is to help patients to protect their sternum when they need to cough or sneeze. The question is: Could such pillows do more harm than good?

Many charity organisations supply the pillows free of charge, all with great intentions. Often the pillows are shaped as a heart, which gives a sense of comfort. They also give the impression that the hospital and its staff care about each patient and his/her recovery. Some pillows may have prints of the anatomical heart and/or the logo of the hospital.

The patient is instructed to hug the pillow, when they need to cough or sneeze. There is one problem with this: The pillow is not attached to the patient, and patients cannot carry it around at all times, like when they need to visit the bathroom. They have to reach out for it, when a cough or sneeze comes up. Will they manage to get the pillow in time? Or has the cough or sneeze already taken place when the pillow got picked up from ...the bed, a chair, a table, or the floor!

Heart pillows can get in touch with many sources of infection. This may present a risk for the sternal wound when the pillows are hugged and pressed against it. Patients continue to use the heart pillow after discharge for a long time, and may bring it around with them in and out of their home. This furthermore exposes the pillow to sources for infection.

Coughing or sneezing causes a sudden rise in internal thoracic pressure. Pressing a pillow against the sternum gives counter-pressure during coughing or sneezing. However, when the patient is not coughing or sneezing, such inward pressure on the fractured sternum bone may disturb a precise alignment of the sternal bone halves and hinder a healthy healing. The problem is that many patients may use pillows for comfort during pain and press it towards the sternum, also when they don't need to cough or sneeze.

Dr. Arthur Tucker, St. Barts and the London Hospitals, is the author of a study reported in the UK news paper The Telegraph (See the article here).
 “Dr. Tucker found 30 different types of infection in a sample of pillows taken from hospital wards, posing a significant risk of infection!” The study was cited by The London Times and reported by Fox News: “Pillows in hospitals have been overlooked as breeding grounds for infectious germs — including superbugs”.

In another study from the University of Manchester “Pillows: A Hot Bed Of Fungal Spores”, reported in Science Daily (See the article here), the authors described how they “discovered millions of fungal spores right under our noses -- in our pillows”.

Medical literature reports that 50% to 80% of sternal wound infections are diagnosed after discharge (1, 2). The cost of sternal wound infections are reported to be between $40,000 to $80,000 (3, 4). Research is needed to verify whether the heart pillows could be a potential culprit for sternal complications.

Heart pillows could do more harm than good for the patients’ health and the health care providers’ bottom line. Hospitals should consider to use specialty products dedicated to sternotomy patients such as QualiBreath sternum and thorax support.

What is your opinion about this? Leave a comment below.

  References:

1. Jonkers D, Elenbaas T, Terporten P, Nieman F, Stobberingh E. Prevalence of 90-days postoperative wound infections after cardiac surgery. European Journal of Cardio-thoracic Surgery 23 (2003) 97–102

2. 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 Dec;20(6):1168-75.

3. Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic aspects of deep sternal wound infections. European Journal of Cardio-thoracic Surgery 37 (2010) 893—896

4. Speir AM, Kasirajan V, Barnett SD, Fonner E. Additive Costs of Postoperative Complications for Isolated Coronary Artery Bypass Grafting Patients in Virginia. Ann Thorac Surg 2009;88:40–6