Treatment of mediastinitis using an open irrigation and delayed sternal reconstruction with a pectoralis major muscle flap

BACKGROUND: Mediastinitis is a very serious complication after cardiac surgery. To date, the optimal treatment of mediastinitis is still controversial: the "closed wound" procedures and the "open wound" treatments are the two conventional modalities reported in the literature. METHODS: Between January 1995 and December 2000, 20 patients, who had previously been submitted to cardiac surgery, were treated by a modification of the "open wound" treatment strategy for postoperative mediastinitis. All patients were scheduled for 2, 6, and 12-month clinical follow-up. The procedure performed consisted of three major steps: 1) early sternum reopening, followed by phase 2) including irrigation of the wound 3 times daily, and the final step 3) of delayed reconstructive surgery using the pectoralis major myocutaneous advancement flap closure technique. We prospectively analyzed the short- and long-term results of these procedures. RESULTS: The overall duration of hospitalization was 25 +/- 10 days; no patient required intensive care unit permanency. Clinical success was achieved in all 20 cases (100%). No recurrences of local (such as fistulas or abscesses) or systemic infections were noted, and no patient required sternal reopening during follow-up. An optimal cosmetic result was obtained in all patients and only 2 cases had persistent sternal pain regressing at the 6-month follow-up control. CONCLUSIONS: Our data suggest that for patients with severe mediastinitis, this treatment strategy is safe. The clinical and esthetic success rates are high, the recovery time rapid, and the rates of short- and long-term complications very low.