Abstract
IntroductionThe aim of our study is to present our experience from the management of six patients with deep sternal wood infection and mediastinitis after aortocoronary by pass grafting.Case seriesFive Caucasian Greek male patients and a Caucasian Greek female were subjected to aortocoronary by pass grafting. Mean time of sternal dehiscence and mediastinitis was 9–17 (mean 11) days. We managed these patients with total sternectomy and transposition of the greater omentum in the thorax. All patients had an uneventful postoperative course.ConclusionWe believe that greater omentum is the ideal reconstruction tissue for deep sternal wound infections and mediastinitis. Timely diagnosis, aggressive sternal debridement and omental flap coverage represent the mainstay of therapy in this highly lethal complication.
Highlights
The aim of our study is to present our experience from the management of six patients with deep sternal wood infection and mediastinitis after aortocoronary by pass grafting.Case series: Five Caucasian Greek male patients and a Caucasian Greek female were subjected to aortocoronary by pass grafting
The most important complication of median sternotomy is the infection of the surgical incision that may lead to sternal dehiscence and osteitis, osteomyelitis and mediastinitis development
Median sternotomy disruption and mediastinitis is a rare complication (0,3–5%) that has been associated with high mortality rates. (14–40%) The main etiologic factors that have been implicated in this complication is obesity, diabetes mellitus, chronic obstructive pulmonary disease, the length of the operation and high volume of blood loss.[1,2]
Summary
The aim of our study is to present our experience from the management of six patients with deep sternal wood infection and mediastinitis after aortocoronary by pass grafting.Case series: Five Caucasian Greek male patients and a Caucasian Greek female were subjected to aortocoronary by pass grafting. The aim of our study is to present our experience from the management of six patients with deep sternal wood infection and mediastinitis after aortocoronary by pass grafting. Mean time of sternal dehiscence and mediastinitis was 9–17 (mean 11) days We managed these patients with total sternectomy and transposition of the greater omentum in the thorax. Newer techniques aim at smaller and minimal invasive chest operations, median sternotomy has many advantages, it can be performed fast, easy and with little if any blood loss. The most important complication of median sternotomy is the infection of the surgical incision that may lead to sternal dehiscence and osteitis, osteomyelitis and mediastinitis development. During the years 2003–2007, 768 patients were subjected to aortocoronary by pass grafting from our department. The basic parameters of the patients' history and operative details can be seen on Table 1
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