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Eur J Cardiothorac Surg 2004;26:232-233
© 2004 Elsevier Science NL

Letter to the Editor

Which is better for treatment of mediastinitis following heart surgery, omental or muscle flap transfer?

Yoshio Misawa*

Division of Cardiovascular Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, Tochigi 329-0498, Japan

Received 2 February 2004; accepted 7 April 2004.

* Tel.: +81-285-58-7368; fax: +81-285-44-6271
e-mail: tcvmisa{at}jichi.ac.jp

Key Words: Post-sternotomy mediastinitis • Cardiac surgery • Muscle flap transfer • Omental transfer

With great interest, I read the paper by Klesius and associates, entitled ‘Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps’ [1]. They conclude that bilateral pectoralis major flap repair is a safe technique to cure severe mediastinitis necessitating complete sternal resection, and that cosmetic results as well as stabilization of the chest were good. Post-sternotomy mediastinitis is problematic for cardiac surgeons because of its lethal outcomes. While I congratulate their excellent clinical results, I have some comments about their strategy for infective mediastinitis.

I have also experienced infective mediastinitis after open-heart surgery [2,3]. Our strategy for mediastinitis is complete debridement and omental transfer with or without continuous mediastinal irrigation for a couple of days. Muscle flap transfer is limited to cases whose omentum is not available because of post-omentectomy or multi-laparotomy. For treatment of infective mediastinitis, occupying the dead space after debridement, antibiotic therapy, and draining exudates are inevitable procedures. The omentum has not only a mass effect but also has properties such as the ability to enhance neovascularization and to absorb exudates in the mediastinum [4]. The additional skin incision to harvest pectoralis major muscle flaps may lead to a more painful post-operative course than that with a median skin incision to harvest the omentum, which requires at most an incision just several centimeters longer than the initial sternotomy.

The study by Klesius and associates shows excellent clinical results; and I agree with them regarding the effectiveness of muscle transfer for treatment of mediastinitis. However, is their strategy one that is employed as the first surgical option? I would choose omental transfer with or without muscle flap transfer as a first strategy.

References

  1. Klesius A.A., Dzemali O., Simon A., Kleine P., Abdel-Rahman U., Herzog C., Wimmer-Greinecker G., Moritz A. Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg 2004;25:218-223.[Abstract/Free Full Text]
  2. Oyama H., Misawa Y., Hasegawa N., Katoh M., Hasegawa T., Fuse K. A successful treatment of infective mediastinitis with chylomediastinum after the closure of atrial septal defect. Kyobu Geka 1994;47:864-865.[Medline]
  3. Misawa Y., Fuse K., Hasegawa T. Infectious mediastinitis after cardiac operations: computed tomographic findings. Ann Thorac Surg 1998;65:622-624.[Abstract/Free Full Text]
  4. Misawa Y., Fuse K. Muscle flap transfer or omental transfer for treatment of poststernotomy mediastinitis. Ann Thorac Surg 1998;66:296-297.[Free Full Text]



This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
V. P. Argitis, P. Schnyder, and L. K. von Segesser
Editorial comment: Bauernschmitt et al. "Pitfall in the computed-tomography-diagnosis of postcardiotomy infection: iodine accumulation after irrigation mimicking retrosternal abscess"
Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 707 - 708.
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