Successful Treatment of Deep Sternal İnfections Following Open Heart Surgery by Pectoralis Major Flaps

Year 2007, Volume: 14 Issue: 2, 115 - 117, 01.04.2007

Vedat Nisanoğlu Nevzat Erdil Tamer Eroğlu Mustafa Aldemir Bülent Özgür Hasan Berat Cihan Bektaş Battaloğlu

Abstract

Severe sternal wound infection following open heart surgery represents a rare but life-threatening complication. It requires prolonged hospitalization and high cost. Debridement and irrigation with saline are the most common used methods for treatment, in case of failure of these treatment regimens, sternal resection and reconstruction with pectoralis muscle flap may be necessary. We reported 4 cases with deep sternal infection after open heart surgery and we introduced our results of strategy on surgical sternal wound debridement and reconstruction with pectoralis major muscle flaps. Key Word: open heart surgery, Sternal infection, Wound treatment, Pectoralis flaps

Keywords

-

Kalp Cerrahisi Sonrası Derin Sternal Enfeksiyonların Pektoral Kas Flepleri ile Başarılı Tedavisi+

Abstract

Kalp cerrahisi sonrası derin sternal yara enfeksiyonu nadir olmakla beraber, hayatı tehdit eden, hastanede kalış süresini ve maliyeti artıran ağır komplikasyonlardan biridir. Debridman ve yaranın izotonik solüsyon ile yıkanması en sık başvurulan yöntemse de, bu tedavilerin yetersiz kaldığı durumlarda sternal rezeksiyon ve pektoral kas flep rekonstrüksiyonu gerekebilir. Bu yazıda, kardiyak cerrahi sonrası derin sternal enfeksiyon gelişen 4 olguda uyguladığımız cerrahi debridman ve pektoral kas flep rekonstrüksiyonu sonuçlarımızı irdeledik. Anahtar kelimeler: Açık kalp cerrahisi, Sternal enfeksiyon, Yara tedavisi, Pektoral flep.

Keywords

Açık kalp cerrahisi, Sternal enfeksiyon, Yara tedavisi, Pektoral flep

References

• Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, Hentschel B, Schmitt DV, Mohr FW, Diegeler A. Mediastinitis and cardiac surgery--an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002;50:87-91.
• El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61:1030-6.
• Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001;20:1168-75.
• Toumpoulis IK, Anagnostopoulos CE, Derose JJ Jr, Swistel DG. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest 2005;127:464-71.
• Lu JC, Grayson AD, Jha P, Srinivasan AK, Fabri BM. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23:943-9.
• Hollenbeak CS, Murphy DM, Koenig S, Woodward RS, Dunagan WC, Fraser VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118:397-402.
• Braxton JH, Marrin CA, McGrath PD, Ross CS, Morton JR, Norotsky M, Charlesworth DC, Lahey SJ, Clough RA, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Mediastinitis and long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg 2000;70:2004-7.
• De Feo M, Renzulli A, Ismeno G, Gregorio R, Della Corte A, Utili R, Cotrufo M. Variables predicting adverse outcome in patients with deep sternal wound infection. Ann Thorac Surg 2001;71:324-31.
• Kirklin JW, Barratt-Boyes BG, 2nd ed. Cardiac surgery, vol. 1. London:Churchill Livingstone; 1993. p.224-6.
• Thurer RJ, Bognolo D, Vargas A, Isch JH, Kaiser GA. The management of mediastinal infection following cardiac surgery. An experience utilizing continuous irrigation with povidone-iodine. J Thorac Cardiovasc Surg 1974;68:962-8.
• Yasuura K, Okamoto H, Morita S, Ogawa Y, Sawazaki M, Seki A, Masumoto H, Matsuura A, Maseki T, Torii S. Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery. Ann Surg 1998;227:455-9.
• Milano CA, Georgiade G, Muhlbaier LH, Smith PK, Wolfe WG. Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann Thorac Surg 1999;67:377-80.
• Satta J, Lahtinen J, Raisanen L, Salmela E, Juvonen T. Options for the management of poststernotomy mediastinitis. Scand Cardiovasc J 1998;32:29-32.
• El Gamel A, Yonan NA, Hassan R, Jones MT, Campbell CS, Deiraniya AK, Lawson RA. Treatment of mediastinitis: early modified Robicsek closure and pectoralis major advancement flaps. Ann Thorac Surg 1998;65:41-6.
• Klesius AA, Dzemali O, Simon A, Kleine P, Abdel-Rahman U, Herzog C, Wimmer- Greinecker G, Moritz A. Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg 2004;25:218-23.