Management with closed irrigation for post-sternotomy mediastinitis: experience with the use of electrolyzed strong acid aqueous solution.
OBJECTIVE
The aim of this study was to assess the adequacy of our treatment strategy for patients with post-sternotomy mediastinitis.


METHODS
Between May 1997 and December 2000, 1,045 consecutive adult cardiac operations were performed at our center. Mediastinitis occurred in 8 patients (0.77%) and as treatment, they underwent (1) aggressive debridement, (2) closed irrigation and drainage, and (3) transvenous administration of antibiotics. We irrigated the mediastinum with 0.1-1.0% povidone-iodine solution, alternating with electrolyzed strong acid aqueous solution. We subsequently reviewed the outcome after the closed irrigation treatment for patients with post-sternotomy mediastinitis.


RESULTS
In four of the 8 patients, the culture specimen grew Methicillin-resistant Staphylococcus aureus. In the others, Serratia marcescens, Staphylococcus epidermidis, Pseudomonas aeruginosa and Gram-negative rods were cultured. The mean period between primary surgery and the diagnosis of mediastinitis was 16.3 (8 -57) days. The mean period between diagnosis of mediastinitis and the start of the irrigation treatment was 0.8 (0-3) days. The mean irrigation period was 30.0 (14-47) days. The irrigation complications were mild hepatic dysfunction in 2 patients, hyponatremia in 2 and protracted wound infection in 1. The hospital mortality was 1/8 (12.5%). Seven survivors are free from recurrent mediastinitis.


CONCLUSIONS
Our experience of closed irrigation and drainage suggests that it can yield satisfactory results after post-sternotomy mediastinitis, comparable to other reported results with or without muscle flaps.
Ohuchi
Shingo
S
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 1-2-1 Chuohdori, Morioka, Iwate 020-8505, Japan.
Kawazoe
Kohei
K
Ishihara
Kazuaki
K
Izumoto
Hiroshi
H
Eishi
Kiyoyuki
K
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003646:Debridement; D004322:Drainage; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D013249:Sternum / Q000601:surgery; D007507:Therapeutic Irrigation / Q000379:methods