title: Evolution in the treatment of mediastinitis: single-center experience.
abstract: This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979-1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995-2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002-2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate.
authors.affiliation: Department of Cardiothoracic Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.forename: Mariano
authors.initials: M
authors.lastname: Vicchio
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santè
authors.forename: Flavio
authors.initials: F
authors.lastname: Cerasuolo
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Nappi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001458:Bandages; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006931:Hyperbaric Oxygenation; D007558:Italy; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010369:Pectoralis Muscles / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents