HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard G. Ohye Eric J. Devaney Edward L. Bove Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ohye, R. G. Articles by Bove, E. L. Search for Related Content PubMed PubMed Citation Articles by Ohye, R. G. Articles by Bove, E. L. Related Collections Mediastinum

J Thorac Cardiovasc Surg 2004;128:480-486
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Primary closure for postoperative mediastinitis in children

^a Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Mich, USA

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication April 29, 2003; revisions received March 31, 2004; accepted for publication April 13, 2004.

^* Address for reprints: Richard G. Ohye, MD, F7830 Mott/0223, 1500 East Medical Center Dr, Ann Arbor, MI 48109, USA
ohye{at}umich.edu

OBJECTIVES: Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children.

METHODS: From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated.

RESULTS: One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients.

CONCLUSIONS: Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

This article has been cited by other articles:

				A. M. Gaca, J. J. Jaggers, L. T. Dudley, and G. S. Bisset III Repair of Congenital Heart Disease: A Primer-Part 1 Radiology, June 1, 2008; 247(3): 617 - 631. [Abstract] [Full Text] [PDF]

				C. Anslot, S. Hulin, and Y. Durandy Postoperative Mediastinitis in Children: Improvement of Simple Primary Closed Drainage Ann. Thorac. Surg., August 1, 2007; 84(2): 423 - 428. [Abstract] [Full Text] [PDF]

				T. Fleck, P. Simon, G. Burda, E. Wolner, and G. Wollenek Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 285 - 288. [Abstract] [Full Text] [PDF]

				A. A. Al-Sehly, J. L. Robinson, B. E. Lee, G. Taylor, D. B. Ross, M. Robertson, and I. M. Rebeyka Pediatric Poststernotomy Mediastinitis Ann. Thorac. Surg., December 1, 2005; 80(6): 2314 - 2320. [Abstract] [Full Text] [PDF]