Abstract
Background
Poststernotomy mediastinitis is a serious complication after open heart surgery. There are currently no specific guidelines with regards to standard treatment.
Methods
This is a prospective cohort study using a source population of 7842 patients who underwent open heart surgery. Between 1999 and 2010, 83 patients were diagnosed with mediastinitis, of which 24 patients underwent reconstruction with bilateral pectoralis major advancement flap. All surviving patients were seen at follow-up, and postoperative functional level was examined. The closing date was October 1, 2011.
Results
Median follow-up time from primary operation was 6.0 (1.6–15.5) years. Median follow-up from postsurgical mediastinitis was26 5.4 (0.4–12.4)years. There was no early mortality, and 22 patients were discharged with complete wound closure and infection control. Quality of life questionnaires revealed significant morbidity with chronic pain and reduced mobility, but despite this, patients were satisfied with their overall health outcome.
Conclusions
Mediastinitis remains a serious postoperative complication after open heart surgery accounting for significant morbidity and mortality. Treatment of deep sternal wound infection by pectoralis major flap reconstruction gives excellent wound closure. Follow-up showed that these patients were multimorbid with reduced quality of life as measured.
Level of Evidence: Level IV, therapeutic study.
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Ethical standards
The study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Patients gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.
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Rashidi, M., Barstad, M.R., Brunborg, C. et al. Bilateral pectoralis muscle advancement flap in the management of deep sternal wound infection: a single clinic study of clinical outcome and postoperative quality of life. Eur J Plast Surg 37, 423–430 (2014). https://doi.org/10.1007/s00238-014-0967-z
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DOI: https://doi.org/10.1007/s00238-014-0967-z