title: Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre, University of Ankara School of Medicine, Dikimevi, Ankara 06340, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Eyileten
authors.forename: Ahmet Ruchan
authors.initials: AR
authors.lastname: Akar
authors.forename: Sadik
authors.initials: S
authors.lastname: Eryilmaz
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sirlak
authors.forename: Levent
authors.initials: L
authors.lastname: Yazicioglu
authors.forename: Serkan
authors.initials: S
authors.lastname: Durdu
authors.forename: Adnan
authors.initials: A
authors.lastname: Uysalel
authors.forename: Umit
authors.initials: U
authors.lastname: Ozyurda
mesh_terms: 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