Aggressive treatment using muscle flaps or omentopexy in infections of the sternum and anterior mediastinum following sternotomy.
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.
Moreschi
Alexandre Heitor
AH
Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil. moreschi_rs@terra.com.br
Macedo Neto
Amarilio Vieira de
AV
Barbosa
Gilberto Venossi
GV
Saueressig
Mauricio Guidi
MG
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