Abstract
Objective: The aim of this study was to assess the adequacy of our treatment strategy for patients with post-sternotomy mediastinitis. Methods: Between May 1997 and December 2000, 1,045 consecutive adult cardiac operations were performed at our center. Mediastinitis occurred in 8 patients (0.77%) and as treatment, they underwent (1) aggressive debridement, (2) closed irrigation and drainage, and (3) transvenous administration of antibiotics. We irrigated the mediastinum with 0.1–1.0% povidone-iodine solution, alternating with electrolyzed strong acid aqueous solution. We subsequently reviewed the outcome after the closed irrigation treatment for patients with post-sternotomy mediastinitis. Results: In four of the 8 patients, the culture specimen grew Methicillin-resistant Staphylococcus aureus. In the others, Serratia marcescens, Staphylococcus epidermidis, Pseudomonas aeruginosa and Gram-negative rods were cultured. The mean period between primary surgery and the diagnosis of mediastinitis was 16.3 (8–57) days. The mean period between diagnosis of mediastinitis and the start of the irrigation treatment was 0.8 (0–3) days. The mean irrigation period was 30.0 (14–17) days. The irrigation complications were mild hepatic dysfunction in 2 patients, hyponatremia in 2 and protracted wound infection in 1. The hospital mortality was 1/8 (12.5%). Seven survivors are free from recurrent mediastinitis. Conclusions: Our experience of closed irrigation and drainage suggests that it can yield satisfactory results after poststernotomy mediastinitis, comparable to other reported results with or without muscle flaps.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Heath BJ, Bagnato VJ. Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage. J Thorac Cardiovasc Surg 1987; 94: 355–60.
Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M, et al. Sternal wound complications after isolated coronary artery bypass grafting: Early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990; 49: 179–86.
Jones G, Jurkiewicz MJ, Bostwick J, Wood R, Bried JT, Culbertson J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 1997; 225: 766–76.
Thomas K, Hetzer R. Contrast media radiography in patients with retrosternal irrigation drainage for severe sternal wound infection. Ann Thorac Cardiovasc Surg 1999; 5: 164–7.
Castello JR, Centella T, Garro L, Barros J, Oliva E, Sanchez-Olaso A, et al. Muscle flap reconstruction for the theatment of major sternal wound infections after cardiac surgery: A 10-year analysis. Scand J Plast Reconstr Hand Surg 1999; 33: 17–24.
d'Udekem Y, Lengele B, Noirhomme P, El Khoury G, Vanwijck R, Rubay JE, et al. Radical debridement and omental transposition for post sternotomy mediastinitis. Cardiovasc Surg 1998; 6: 415–8.
Yokoyama H, Sadahiro M, Iguchi A, Ohmi M, Tabayashi K, Tanaka S. Remnant omental transfer for the mediastinitis after coronary bypass surgery with right gastroepiploic artery. Ann Thorac Surg 1999; 68: 269–71.
EL Oakley RM, Wright JE. Postoperative mediastinitis: Classification and management. Ann Thorac Surg 1996; 61: 1030–6.
Hayashi H, Kumon K, Yahagi N, Haruna M, Watanabe Y, Matsui J, et al. Succssful treatment of mediastinitis after cardiovascular surgery using electrolyzed strong acid aqueous solution. Artif Organs 1997; 21: 39–42.
Inoue Y, Endo S, Kondo K, Ito H, Omori H, Saito K. Trial of electrolyzed strong acid aqueous solution lavage in the treatment of peritonitis and intraperitoneal abscess. Artif Organs 1997; 21: 28–31.
Berg HF, Brands WGB, van Geldorp TR, Kluytmans-VandenBergh MFQ, Kluytmans JAJW. Comparison between closed drainage techniques for the treatment of postoperative mediastinitis. Ann Thorac Surg 2000; 70: 924–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ohuchi, S., Kawazoe, K., Ishihara, K. et al. Management with closed irrigation for post-sternotomy mediastinitis. Jpn J Thorac Caridovasc Surg 51, 511–514 (2003). https://doi.org/10.1007/s11748-003-0112-6
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11748-003-0112-6