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Surgery Today

, Volume 39, Issue 11, pp 947–954 | Cite as

Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery

  • Zeynep Eyileten
  • Ahmet Ruchan Akar
  • Sadik Eryilmaz
  • Mustafa Sirlak
  • Levent Yazicioglu
  • Serkan Durdu
  • Adnan Uysalel
  • Umit Ozyurda
Original Article

Abstract

Purpose

To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.

Methods

Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 ± 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 ± 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.

Results

The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 ± 10.8 days (range 5–62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (P = 0.046). Hospital mortality after treatment was 4.6% (n = 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Acinetobacter species (n = 1). The median hospital stay was 29 days (range 15–110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.

Conclusions

Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.

Key words

Sternotomy Dehiscence Deep sternal wound infection Mediastinitis Complications 

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Copyright information

© Springer 2009

Authors and Affiliations

  • Zeynep Eyileten
    • 1
  • Ahmet Ruchan Akar
    • 1
  • Sadik Eryilmaz
    • 1
  • Mustafa Sirlak
    • 1
  • Levent Yazicioglu
    • 1
  • Serkan Durdu
    • 1
  • Adnan Uysalel
    • 1
  • Umit Ozyurda
    • 1
  1. 1.Department of Cardiovascular Surgery, Heart CentreUniversity of Ankara School of MedicineDikimevi, AnkaraTurkey

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