Early Repair of Sternal Instability Prevents Mediastinitis

Abstract

Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

Flail chest and mediastinitis with total sternal loss post pediatric heart surgery. Reconstruction technique and case report

“…La infección de sitio quirúrgico profundo conocida como infección posesternotomía del espacio mediastínico o mediastinitis, es una complicación grave de la cirugía cardíaca que puede estar asociada a osteomielitis esternal 1 , 2 . Tiene una incidencia de entre 0,2 al 5% 3 , con una tasa de mortalidad de hasta 40% 4 . En cirugía cardiaca pediátrica se han reportado una incidencia entre 1,7 a 8,0 por 100 casos 1 .…”

Cold-plasma sternotomy and postoperative sternal consolidation

“…На сегодняшний день в мире наиболее распространенным хирургическим доступом при операциях на сердце является полная продольная срединная стернотомия [11]. Этот доступ нашел широкое применение и в торакальной хирургии благодаря возможности манипулировать на всех основных структурах переднего средостения.…”