Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of São Paulo Medical School.

Vitor Penteado Figueiredo Pagotto,Fabio B Jatene,Rolf Gemperli,Igor Castro Carneiro,Samuel Terra Gallafrio

doi:10.21470/1678-9741-2020-0117

Vitor Penteado Figueiredo Pagotto, Fabio B Jatene + Show 3 more

Open Access

https://doi.org/10.21470/1678-9741-2020-0117

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Journal: Revista Brasileira de Cirurgia Cardiovascular	Publication Date: Jan 1, 2021
Citations: 1	License type: cc-by

Abstract

This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.

Highlights

Median sternotomy has been established as the gold standard access to cardiac surgery
We present the treatment and final chest reconstruction for mediastinitis following sternotomy for cardiac surgery at Incor-FMUSP
Several risk factors are related to the development of mediastinitis

Summary

INTRODUCTION

Median sternotomy has been established as the gold standard access to cardiac surgery. Continuous NPWT at 125 mmHg is performed After another interval of five to seven days, the patient returns to the operating room for the third time. Patients with stable sternum and no associated osteomyelitis are reconstructed with the advancement of bilateral pectoral fasciocutaneous flap This alternative ensures adequate wound coverage with well-vascularized and viable tissue without the need for new surgical access and with less risk of adverse effects of muscle transfer, such as hematoma and decreased upper limb strength. When the patient remains with some degree of sternal instability or bone loss after debridement, reconstruction is performed with a unilateral pectoralis major muscle flap on the non-dominant side, associated with the advancement of the bilateral pectoral fasciocutaneous flap (Figure 3). Sternal resection exposes mediastinal structures more sharply, and flaps that allow more tissue transfer are preferred[4] (Figure 5)

DISCUSSION

CONCLUSION