Treatment of postoperative sternal dehiscence with mediastinitis: Twenty-four–year use of a single method

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 132; no. 4; pp. 782 - 787
• Main Authors: Molina, J. Ernesto, Nelson, Elaine C., Smith, Robin R.A.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.10.2006; AATS/WTSA; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Clinical Protocols; Humans; Mediastinitis - complications; Mediastinitis - surgery; Medical sciences; Middle Aged; Postoperative Complications - surgery; Sternum - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical Wound Dehiscence - complications; Surgical Wound Dehiscence - surgery; Surgical Wound Infection - complications; Surgical Wound Infection - surgery; Thoracic Surgical Procedures - methods; Time Factors; 23; 13; 18; Heart; Postoperative; Methodology; Sternum; Mediastinum disease; Use; Thorax; Method; Treatment; Surgery; Dehiscence; Mediastinitis; Technique
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.06.008

Postoperative deep sternal wound infection with dehiscence carries a high mortality rate, a high morbidity rate, and a poor cure rate. We developed a standard protocol of care to treat this complication, achieving primary closure and cure of the infection. From January 1, 1981, through May 31, 2005 (24 years 5 months), we treated 114 patients with dehiscence and mediastinitis. The diagnosis was made from 4 to 56 days (mean, 14.5 days) after surgery. Mean age was 64.3 years (range, 38-84 years); 79 (69%) were obese, and 48 (42%) had diabetes. Ten had previous attempts (1-4) of repair with other methods. Treatment entailed (1) debridement without removal of bone, (2) bilateral dissection of skin and subcutaneous tissue as one layer, (3) implantation of a staggered double-tube irrigation-suction system posterior and another one anterior to the sternum, (4) lateral reinforcement of the sternum and reclosure with a double wire, and (5) a single-layer closure of the subcutaneous tissue and skin. Of 114 patients, 109 (96%) had mediastinitis, positive for Staphylococcus species in 101 (92.6%). The cure rate was 98% (112/114); hospital stay was 14 days (range, 12-16 days), with no deaths. Use of this standard protocol is effective and highly recommended. It spares the sternum, cures the infection, and leaves the patient physically functional without the use of soft tissue flaps.