title: Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study.
abstract: OBJECTIVE
  Pediatric patients are at a risk of mediastinitis, a life-threatening complication of median sternotomy, following cardiac surgery for congenital conditions. Our experience with rigid internal sternal fixation in pediatric patients with postmedian sternotomy mediastinitis is presented.
  
  
  METHODS
  A retrospective chart review was performed of patients <18 years of age diagnosed with postoperative mediastinitis between January 1, 1990 and December 31, 2009. Charts were reviewed for demographic data, cardiac history, causative microorganism, and infectious risk factors. The methods of surgical intervention including flap coverage and use and type of sternal plating (resorbable and/or titanium) were also recorded. The primary end point of interest was overall survival.
  
  
  RESULTS
  Twenty-five pediatric patients were diagnosed with postoperative mediastinitis. Rigid fixation of the sternum following debridement was performed in 20 patients (age range: 1 month-18 years), all of whom successfully tolerated the procedure. Resorbable plates were used in 13 patients. Five patients did not undergo rigid fixation due to either serious ill-health or lack of adequate sternal bone stock. No patient experienced recurrent sternal wound infection. A total of 20 patients (80%) survived to discharge. Three patients succumbed to their heart condition prior to rigid fixation, one died following sternal closure from unrelated causes, and one patient was lost to follow-up.
  
  
  CONCLUSIONS
  Post-sternotomy mediastinitis in pediatric patients may be addressed using wide debridement, rigid sternal fixation, and flap coverage. In our series of 25 patients with pediatric mediastinitis, none died from mediastinitis. Placement of hardware did not adversely affect patient survival. This study demonstrates the feasibility of rigid sternal fixation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Roughton
authors.affiliation: Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Song
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, IL, USA. Electronic address: lgottlie@surgery.bsd.uchicago.edu.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Gottlieb
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008137:Longitudinal Studies; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013524:Surgical Flaps; D015996:Survival Rate
keywords: Cardiac; Congenital; Mediastinitis; Pectoralis flaps; Resorbable plates; Sternal plates