Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis
| Autor: | J. Ennker, Ina Carolin Ennker, Alexander Albert, L. Vöhringer, Peter M. Vogt, D. Pietrowski, B Kojcici |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Sternum medicine.medical_treatment Risk Assessment Surgical Flaps Pectoralis Muscles Cohort Studies medicine Humans Surgical Wound Infection Pectoralis Muscle Survival rate Aged Probability Retrospective Studies Wound Healing Debridement Chi-Square Distribution business.industry Retrospective cohort study Middle Aged Plastic Surgery Procedures Thoracic Surgical Procedures medicine.disease Mediastinitis Sternotomy Surgery Cardiac surgery Survival Rate Treatment Outcome ROC Curve Median sternotomy Multivariate Analysis Female business Negative-Pressure Wound Therapy Follow-Up Studies |
| Zdroj: | Journal of plastic, reconstructiveaesthetic surgery : JPRAS. 62(11) |
| ISSN: | 1878-0539 |
| Popis: | In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus odds ratio (OR 3.5), chronic obstructive pulmonary disease (COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and obesity (1.8). The median age of patients with deep sternal infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum therapy in conjunction with early and aggressive debridement is an effective strategy for treating poststernotomy mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for wound closure in poststernotomy mediastinitis. |
| Databáze: | OpenAIRE |
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