title: Aggressive treatment using muscle flaps or omentopexy in infections of the sternum and anterior mediastinum following sternotomy.
abstract: OBJECTIVE
  To evaluate the impact of an aggressive treatment approach using muscle flaps or omentopexy in infections of the sternum and anterior mediastinum following sternotomy on mortality, as compared to that of a conservative treatment approach.
  
  
  METHODS
  Data were collected prior to, during and after the surgical procedures. Group A (n = 44) included patients submitted to conservative treatment-debridement together with resuture or continuous irrigation with polyvinylpyrrolidone-iodine solutions, or even with second-intention wound healing (retrospective data). Group B (n = 9) included patients in whom infection was not resolved with conservative treatment, and who therefore underwent aggressive treatment (intermediate phase). Group C (n = 28) included patients primarily submitted to aggressive treatment (prospective data).
  
  
  RESULTS
  Postoperative hospital stays were shorter in the patients submitted to aggressive treatment (p < 0.046). There were 7 deaths in group A, 1 in group B, and 2 in group C. However, the classical level of significance of alpha = 0.05 was not reached.
  
  
  CONCLUSIONS
  Aggressive treatment also proved to be effective when the infection was not resolved with conservative treatment. These findings demonstrate that the proposed treatment provides excellent results.
authors.affiliation: Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil. moreschi_rs@terra.com.br
authors.forename: Alexandre Heitor
authors.initials: AH
authors.lastname: Moreschi
authors.forename: Amarilio Vieira de
authors.initials: AV
authors.lastname: Macedo Neto
authors.forename: Gilberto Venossi
authors.initials: GV
authors.lastname: Barbosa
authors.forename: Mauricio Guidi
authors.initials: MG
authors.lastname: Saueressig
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003646:Debridement; D004322:Drainage; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000601:surgery*; D009852:Omentum / Q000601:surgery*; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D010369:Pectoralis Muscles / Q000637:transplantation*; D011184:Postoperative Period; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome