In cardiac surgery poststernotomy
mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with
vacuum-assisted closure (VAC)
therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal
wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using
median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC
therapy was employed.
Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal
wound infections and were treated with VAC. The most common risk factors were
diabetes mellitus odds ratio (OR 3.5),
chronic obstructive pulmonary disease (
COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and
obesity (1.8). The median age of patients with deep sternal
infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum
therapy in conjunction with early and aggressive
debridement is an effective strategy for treating poststernotomy
mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for
wound closure in poststernotomy
mediastinitis.