PMID- 11574218
OWN - NLM
STAT- MEDLINE
DCOM- 20011207
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 20
IP  - 4
DP  - 2001 Oct
TI  - Aggressive primary treatment for poststernotomy acute mediastinitis: our 
      experience with omental- and muscle flaps surgery.
PG  - 743-6
AB  - OBJECTIVE: 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.
FAU - Schroeyers, P
AU  - Schroeyers P
AD  - Department of Thoracic and Cardiovascular Surgery, Onze-Lieve-Vrouw Ziekenhuis, 
      Moorselbaan 164, 9300 Aalst, Belgium.
FAU - Wellens, F
AU  - Wellens F
FAU - Degrieck, I
AU  - Degrieck I
FAU - De Geest, R
AU  - De Geest R
FAU - Van Praet, F
AU  - Van Praet F
FAU - Vermeulen, Y
AU  - Vermeulen Y
FAU - Vanermen, H
AU  - Vanermen H
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
CIN - Eur J Cardiothorac Surg. 2002 Apr;21(4):765; author reply 767. PMID: 11932183
CIN - Eur J Cardiothorac Surg. 2002 Apr;21(4):766; author reply 767. PMID: 11932184
MH  - Aged
MH  - *Coronary Artery Bypass
MH  - Female
MH  - Humans
MH  - Male
MH  - Mediastinitis/mortality/*surgery
MH  - Postoperative Complications/mortality/surgery
MH  - Reoperation
MH  - Risk Factors
MH  - Sternum/*surgery
MH  - *Surgical Flaps
MH  - Surgical Wound Infection/mortality/*surgery
MH  - Survival Rate
EDAT- 2001/09/28 10:00
MHDA- 2002/01/05 10:01
CRDT- 2001/09/28 10:00
PHST- 2001/09/28 10:00 [pubmed]
PHST- 2002/01/05 10:01 [medline]
PHST- 2001/09/28 10:00 [entrez]
AID - S1010794001008739 [pii]
AID - 10.1016/s1010-7940(01)00873-9 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2001 Oct;20(4):743-6. doi: 
      10.1016/s1010-7940(01)00873-9.