Abstract
We report a case of severe mediastinitis infected by methicillin-resistantStaphylococcus aureus (MRSA) after a coronary arterial bypass using the internal thoracic arteries and the right gastroepiploic artery (RGEA) in which mediastinitis was treated by an omental transfer. The patient was a 60-year-old man diagnosed as having an acute myocardial infarction of the left anterior wall. There was severe coronary stenosis of three vessels involving the left main trunk. The patient underwent a coronary arterial bypass with four grafts using the internal thoracic arteries, the RGEA, and the saphenous vein. Postoperative heart failure led to wound infection, resulting in mediastinitis infected by MRSA. Debridement and immediate closure with omental drainage was successfully performed without irrigation. After the establishment of the RGEA graft, the omentum is still viable and usable for mediastinal drainage.
This is a preview of subscription content, log in via an institution to check access.
References
Pairolero PC, Arnold PG (1986) Management of infected median sternotomy wounds. Ann Thorac Surg 42:1–2
Scully HE, Leclerc Y, Martin RD, Tong CP, Goldman BS, Weisel RD, Mickleborough LL, Baird RJ (1985) Comparison between antibiotic irrigation and mobilization of pectoral muscle flaps in treatment of deep sternal infections. J Thorac Cardiovasc Surg 90:523–531
Pailolero PC, Arnold PG (1979) Management of recalcitrant median sternotomy wounds. J Thorac Cardiovasc Surg 88:357–364
Jeevanandam V, Smith CR, Rose EA, Malm JR, Hugo NE (1990) Single-stage management of sternal would infections. J Thorac Cardiovasc Surg 99:256–263
Sarr MG, Gott VL, Townsend TR (1984) Mediastinat infection after cardiac surgery. Ann Thorac Surg 38:415–423
Heath BJ, Bagnat VJ (1987) Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage. J Thorac Cardiavasc Surg 94:355–360
Majore JA, Arbin RE, O'Donnell RS, Arganese TJ (1986) Reconstruction of the infected median sternotomy wound. Ann Thorac Surg 42:9–12
Michels NA (1955) Blood supply and anatomy of the upper abdominal organs. JB Lippincott, Philadelphia, pp 263–265
Tavilla G, Berreklouw E, Schonberger JPAM, Bavinick JH, Prins J (1993) An anatomical variation of the right gastroepiploic artery that excludes its use as a pedicled coronary bypass graft. J Cardiovasc Surg 34:59–61
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sueda, T., Kanehiro, K., Morita, S. et al. Mediastinitis with an infection of methicillin-resistantStaphylococcus aureus treated by an omental transfer following CABG using a right gastroepiploic arterial graft: Report of a case. Surg Today 24, 638–640 (1994). https://doi.org/10.1007/BF01833731
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01833731