Treatment of mediastinitis in children after cardiac surgery

Abstract

Twenty-three cases of mediastinitis after cardiac surgery in children were treated by us between 1973 and 1976. Three patients died within 6 hours of admission. Treatment used in the tweny other cases are discussed. The mean age of the patients was three years and three months. The mediastinitis was evident an average of twelve days after extracoporeal circulation. A staphylococus was always responsible for the infection. Treatment was a combination of surgery, antibiotics and respiratory and nutritional supplies. The surgical treatment consisted of a careful mediastinal cleansing with resection of the sternal edges. In fifteen patients the thorax was closed after surgery, and an irrigation system installed using a solution of 4% Dakin in physiologic saline. Recovery was simple in 5 patients. In the 10 other patients of this group the thorax had to be reopened; one patient died after 90 days from Serratia marcescens endocarditis. The thorax was left open initially in five patients: one patient of this group died from candida endocarditis. All patients needed endotracheal ventilation through a nasotracheal tube (7 to 90 days of ventilation). Treatment with bactericidal antibiotics was pursued for three months and a monotherapy was kept for nine months. After reviewing the observed complications, our methods and results are compared with others in the literature.

Management of Sternal Wounds With Pectoralis Major Musculocutaneous Advancement Flaps in Patients With a History of Chest Wall Irradiation

“…Early treatments included debridement, packing, and/or primary closure with or without placement of antimicrobial irrigation catheters. 17,18 Advances in the treatment of poststernotomy infections were seen with the importation of vascularized tissue. 15,18 -21 Our preferred approach is debridement followed by immediate reconstruction with bilateral pectoralis major musculocutaneous advancement flaps as described by Hugo et al 22 in 1994. In this approach, the patient is taken to the operating room as soon as the diagnosis of sternal wound infection is strongly suspected.…”

Open Discussion

“…[11][12][13] Mediastinitis may significantly increase morbidity and mortality rates. 17,18 Advances in the treatment of poststernotomy infections were seen with the importation of vascularized tissue. 12,15,16 Recommendations for optimal treatment of sternal wound complications have changed over the years.…”