Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery.
OBJECTIVE
To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.


METHODS
Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 +/- 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 +/- 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.


RESULTS
The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 +/- 10.8 days (range 5-62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (P = 0.046). Hospital mortality after treatment was 4.6% (n = 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Acinetobacter species (n = 1). The median hospital stay was 29 days (range 15-110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.


CONCLUSIONS
Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.
Eyileten
Zeynep
Z
Department of Cardiovascular Surgery, Heart Centre, University of Ankara School of Medicine, Dikimevi, Ankara 06340, Turkey.
Akar
Ahmet Ruchan
AR
Eryilmaz
Sadik
S
Sirlak
Mustafa
M
Yazicioglu
Levent
L
Durdu
Serkan
S
Uysalel
Adnan
A
Ozyurda
Umit
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010369:Pectoralis Muscles / Q000637:transplantation*; D012189:Retrospective Studies; D056346:Sternotomy; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome