JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
J. Ernesto Molina
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Molina, J. E.
Right arrow Articles by Smith, R. R.A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Molina, J. E.
Right arrow Articles by Smith, R. R.A.
Related Collections
Right arrow Cardiac - other
Right arrow Coronary disease

J Thorac Cardiovasc Surg 2006;132:782-787
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

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

J. Ernesto Molina, MD, PhD*, Elaine C. Nelson, RN, CNS, Robin R.A. Smith, RN, CNP

Department of Surgery, Division of Cardiothoracic Surgery, University of Minnesota Medical School, Minneapolis, Minn.

Received for publication March 10, 2006; revisions received May 5, 2006; accepted for publication June 7, 2006.

* Address for reprints: J. Ernesto Molina, MD, PhD, Division of Cardiothoracic Surgery, 420 Delaware St. SE/MMC 107, Minneapolis, MN 55455. (Email: molin001{at}umn.edu).

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.




This article has been cited by other articles:


Home page
 ICVTSHome page
C. Schimmer, S.-P. Sommer, M. Bensch, and R. Leyh
Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers
Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 708 - 711.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.