title: Deep-seated infective mediastinitis in post-coronary artery bypass grafting patients.
abstract: The median sternotomy is the preferred incision for coronary artery bypass grafting (CABG) but its usage was initially associated with wound infection rates of up to 5%. The advent of antibiotic prophylaxis and improved surgical technique has improved these rates to 1% to 2% in most series. During a 5-year period from January 1988 to December 1992, 2193 patients underwent CABG in the Singapore General Hospital. Of these, 22 (1%) suffered postoperative wound infection. Thirteen (0.59%) of these had deep-seated mediastinitis which involved the osteocartilagenous tissues and retrosternal space and 9 (0.41%) had superficial wound infections. The superficial infections were successfully treated with dressings and delayed closure in all cases. The deep-seated infections, however, required in addition, antibiotic therapy, povidone iodine irrigation, repeated debridement and flap closure. In total, 6 muscle and myocutaneous flaps were used with good result. This paper reviews the Plastic Surgery unit's experience in treating this difficult postoperative complication.
authors.affiliation: Department of Plastic Surgery, Singapore General Hospital.
authors.forename: A K
authors.initials: AK
authors.lastname: Khoo
authors.forename: K C
authors.initials: KC
authors.lastname: Tan
authors.forename: K K
authors.initials: KK
authors.lastname: Ong
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000628:therapy; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents