From June 1964 to Dec. 1989, 1228 patients underwent cardiovascular operations by
median sternotomy approach in our hospital. 18 of them (1.4%) were complicated by retrosternal
infections and were treated successfully. Of these 18, 3 were treated by conservative method (Group 1), that is, local
debridement and drainage. The other 15 were managed by a radical technique (Group 2) which includes reopening of the chest, radical
debridement of retrosternal mediastinum, primary sternal reclosure and continuous retrosternal irrigation with
antibiotic solutions. There was no hospital death. The mean healing time of the infected
wounds was 91 days in Group 1, and 24 days in Group 2. Recurrence of
wound infections was found in 2 cases in Group 1. Primary healing was obtained in all patients but 1 in Group 2 after initial
debridement. The authors considered that (1) Early radical
debridement with continuous irrigation is very effective for management of retrosternal
infection; (2) Radical
debridement should be done as early as the diagnosis of
infection is established.