Simplified treatment of postoperative mediastinitis.
BACKGROUND
Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication. A variety of treatment plans have been advocated, and there is lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis who have been treated in a simple, consistent manner.


METHODS
We reviewed our experience with 40 consecutive patients with mediastinitis who were treated between January 1995 and May 2003 with a single-stage treatment consisting of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Tubes were placed posterior to the sternum in all patients and were irrigated continuously for at least 7 days with antibiotic or antibacterial solution. Systemic antibiotics were selected based on culture and sensitivity data and were administered for 2 to 6 weeks.


RESULTS
All patients with mediastinitis treated in this manner survived. Of the 40 patients, 38 achieved complete healing of the wound without further operative intervention or major complication. One patient had recurrent infection and required sternal resection and advancement of muscle flaps. One patient had a residual localized focus of chondritis and underwent limited resection of cartilage.


CONCLUSIONS
In this series of patients with postoperative mediastinitis, a simplified approach consisting of wound debridement, reclosure over drains, and anterior mediastinal irrigation has been an effective treatment. The results we have achieved suggest that this technique may be a suitable option for treating this condition.
Department of Surgery and Heart and Vascular Center, Section of Cardiothoracic Surgery, University of Cincinnati, Cincinnati, OH, USA. walter.merrill@uc.edu
Walter H
WH
Merrill
Shahab A
SA
Akhter
Randall K
RK
Wolf
E William
EW
Schneeberger
John B
JB
Flege
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002177:Candidiasis / Q000188:drug therapy / Q000601:surgery; D015505:Chest Tubes; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000601:surgery*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013396:Suction; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000601:surgery*; D007507:Therapeutic Irrigation; D019616:Thoracic Surgical Procedures
D000900:Anti-Bacterial Agents