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Eur J Cardiothorac Surg 2001;20:743-746
© 2001 Elsevier Science NL

Aggressive primary treatment for poststernotomy acute mediastinitis: our experience with omental- and muscle flaps surgery

Department of Thoracic and Cardiovascular Surgery, Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium

Received 5 February 2001; received in revised form 12 June 2001; accepted 19 June 2001.

Corresponding author. Tel.: +32-53-72-45-99; fax: +32-53-72-45-52
e-mail: francis.wellens{at}olvz-aalst.be

Obhective: The surgical treatment of poststernotomy acute mediastinitis remains challenging. After disappointing results with a conservative management of post coronary artery bypass grafting (CABG) mediastinitis, we shifted towards a more aggressive surgical management. Methods: From March 1993 until December 1999, 32 patients (6 female/26 male), 0.5% of the total sternotomy population, were operated for mediastinitis, defined as wound and sternal dehiscence with medistinal pus and positive culture. Mean age was 66 years (32–79 years). Twenty-two patients (75%) underwent CABG and 16 patients were in New York Heart Association (NYHA) class III/IV. Results: We performed an omentoplasty in 11 patients, a pectoralis muscle flap associated with an omentoplasty in 20 patients. One patient had a bilateral pectoralis myoplasty. The reconstruction surgery occurred at an average of 11 days (6–26) after primary surgery. Twelve patients had a previous surgical drainage (1–3 surgical procedures) of the mediastinum. Hospital mortality was nine patients (28%). Seven of these patients (77%) were in NYHA IV with inotropic support. Five patients had to be reoperated on: four patients had a bilateral myoplasty after omentoplasty, one patient had an omentoplasty after a unilateral myoplasty. Late epigastric hernia was seen in three patients, two patients had wound revision and one had a retroperitoneal drainage for pancreatitis. There were no early or late flap failures. Conclusion: In our experience, omental and pectoralis flaps for poststernotomy acute mediastinitis provides good outcome of our stable patients. We would be reluctant to use it as standard therapy in our unstable patients.

Key Words: Poststernotomy mediastinitis • Omental and pectoralis plasty

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