Abstract
BackgroundTo report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flapsMethodsFrom February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve.ResultsSuperficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days.ConclusionPost cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.
Highlights
The incidence of mediastinal wound infection in patients undergoing median sternotomy and open-heart surgery can be up to 5%[1], [2]
Sternal wound infections were diagnosed in 3.34% of the CABG patients, 3.79% of the CABG and Valves and 3% of the Valve patients
Concomitant leg wound infection was found in 13 patients (10.84%)
Summary
The incidence of mediastinal wound infection in patients undergoing median sternotomy and open-heart surgery can be up to 5%[1], [2]. A subgroup of 20-30% of those patients [3] develops deep sternal infections with an associated morbidity, mortality, and “cost” that remain unacceptably high [4]. There is a considerable lack of consensus regarding the ideal operative treatment of complicated (class 2b) El Oakley [5] sternal wounds. Current treatment with radical sternal debridement and closure using muscle or omental flaps has become popular and is possibly associated with lower mortality. This paper reports our experience on the management. Emphasis was given to the management of deep infections with omental flaps
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