Aggressive primary treatment for poststernotomy acute mediastinitis: our experience with omental- and muscle flaps surgery

• Published in: European journal of cardio-thoracic surgery 2001-10, Vol.20 (4), p.743-746
• Main Authors: Schroeyers, Pascal, Wellens, Francis, Degrieck, Ivan, De Geest, Raf, Van Praet, Frank, Vermeulen, Yvette, Vanermen, Hugo
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Coronary Artery Bypass; Female; Humans; Male; Mediastinitis - mortality; Mediastinitis - surgery; Medical sciences; Omental and pectoralis plasty; Postoperative Complications - mortality; Postoperative Complications - surgery; Poststernotomy mediastinitis; Reoperation; Risk Factors; Sternum - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Surgical Flaps; Surgical Wound Infection - mortality; Surgical Wound Infection - surgery; Survival Rate
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)00873-9

Obhective: The surgical treatment of poststernotomy acute mediastinitis remains challenging. After disappointing results with a conservative management of post coronary artery bypass grafting (CABG) mediastinitis, we shifted towards a more aggressive surgical management. Methods: From March 1993 until December 1999, 32 patients (6 female/26 male), 0.5% of the total sternotomy population, were operated for mediastinitis, defined as wound and sternal dehiscence with medistinal pus and positive culture. Mean age was 66 years (32–79 years). Twenty-two patients (75%) underwent CABG and 16 patients were in New York Heart Association (NYHA) class III/IV. Results: We performed an omentoplasty in 11 patients, a pectoralis muscle flap associated with an omentoplasty in 20 patients. One patient had a bilateral pectoralis myoplasty. The reconstruction surgery occurred at an average of 11 days (6–26) after primary surgery. Twelve patients had a previous surgical drainage (1–3 surgical procedures) of the mediastinum. Hospital mortality was nine patients (28%). Seven of these patients (77%) were in NYHA IV with inotropic support. Five patients had to be reoperated on: four patients had a bilateral myoplasty after omentoplasty, one patient had an omentoplasty after a unilateral myoplasty. Late epigastric hernia was seen in three patients, two patients had wound revision and one had a retroperitoneal drainage for pancreatitis. There were no early or late flap failures. Conclusion: In our experience, omental and pectoralis flaps for poststernotomy acute mediastinitis provides good outcome of our stable patients. We would be reluctant to use it as standard therapy in our unstable patients.