title: Treatment of postoperative sternal dehiscence with mediastinitis: twenty-four-year use of a single method.
abstract: OBJECTIVE
  Postoperative deep sternal wound infection with dehiscence carries a high mortality rate, a high morbidity rate, and a poor cure rate. We developed a standard protocol of care to treat this complication, achieving primary closure and cure of the infection.
  
  
  METHODS
  From January 1, 1981, through May 31, 2005 (24 years 5 months), we treated 114 patients with dehiscence and mediastinitis. The diagnosis was made from 4 to 56 days (mean, 14.5 days) after surgery. Mean age was 64.3 years (range, 38-84 years); 79 (69%) were obese, and 48 (42%) had diabetes. Ten had previous attempts (1-4) of repair with other methods. Treatment entailed (1) debridement without removal of bone, (2) bilateral dissection of skin and subcutaneous tissue as one layer, (3) implantation of a staggered double-tube irrigation-suction system posterior and another one anterior to the sternum, (4) lateral reinforcement of the sternum and reclosure with a double wire, and (5) a single-layer closure of the subcutaneous tissue and skin.
  
  
  RESULTS
  Of 114 patients, 109 (96%) had mediastinitis, positive for Staphylococcus species in 101 (92.6%). The cure rate was 98% (112/114); hospital stay was 14 days (range, 12-16 days), with no deaths.
  
  
  CONCLUSIONS
  Use of this standard protocol is effective and highly recommended. It spares the sternum, cures the infection, and leaves the patient physically functional without the use of soft tissue flaps.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, Minn, USA. molin001@umn.edu
authors.forename: J Ernesto
authors.initials: JE
authors.lastname: Molina
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Nelson
authors.forename: Robin R A
authors.initials: RR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D006801:Humans; D008480:Mediastinitis / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000150:complications / Q000601:surgery*; D013530:Surgical Wound Infection / Q000150:complications / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods; D013997:Time Factors