Management of poststernotomy mediastinitis with vacuum therapy following pectoralis plastic

Abstract

Aims: In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with soft tissue flaps as treatment for deep sternal wound infections. Method: We performed a retrospective analysis of 4200 consecutive cardiac surgical patients (pts) using median sternotomy from 11/2004 to 8/2007. After removing of sternal wires, necrotic debris and potentially infective material restabilization of the sternum were performed and VAC-therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Results: Of the analyzed patients 15 female and 28 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus (OR 3.5), COPD (OR 2.9), use of bilateral mammarian artery (OR1.6) and obesity (1.3). Median age of patients with deewp sternal infections was 69y and 68y in control-pts. Staphylococcus epidermis was the most common pathogen (37.8%) followed by enterococcus faecilis (18.9%) and staphylococcus aureus (13.5). In 13.5% no pathogen could be detected. The 30d mortality was 0%, the in hospital mortality was 13.9%. Due to bleeding complications 6 pts underwent re-surgery. In one patient a partial necrosis of the muscle was observed. Conclusion: The results of our studies demonstrate that vacuum therapy is an important tool for treating poststernotomy mediastinitis. We consider pectoralis major flap reconstruction as a safe technique and regarded it as an important adjunct to the treatment of poststernotomy mediastinitis.