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Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap

Yıl 2023, Cilt: 26 Sayı: 2, 88 - 95, 12.07.2023

Öz

Introduction: Mediastinitis is a rare occurrence following cardiac surgeries; however, it is a significant cause of both mortality and morbidity. Given the significance of mediastinal infections, early diagnosis, and treatment become of paramount importance. The management of this condition necessitates a multidisciplinary approach, involving collaboration and coordination among various medical specialties.
Patients and Methods: 21 patients with a diagnosis of deep mediastinal infection who were treated at Eskişehir Osmangazi University Medical Faculty Hospital between January 2015 and May 2021 were included in the study. Broad-spectrum antibiotic therapy, serial debridement, and vacuum-assisted closure were applied to all patients. Among the patients who exhibited negative blood cultures and developed granulation tissue, those with tissue losses that did not extend to the sternum incision sites were assessed for potential flap procedures in conjunction with plastic and reconstructive surgery. In such cases, closure of the wound was achieved using a pectoral muscle flap. All patients were followed for one year.
Results: Among the patients, 14 (66.6%) were female and seven (33.3%) were male, with a mean age of 62.7 ± 6.5 (range: 41-76 years). Three of the 21 patients included in the study had type I, two had type II, and 16 had type IIIA mediastinitis. Staphylococcus aureus (S. aureus) was the most commonly isolated microorganism with 11 patients (52.3%). The right pectoralis major muscle was used in four patients (19%), the left pectoralis major muscle in four patients (19%), and the bilateral pectoralis major muscle in 13 patients (62%). There was no need for re-intervention in the follow-up of the patients. No mortality because of infection, surgical muscle flap closure, and/or cardiac causes was observed in any of the patients who were treated.
Conclusion: Mediastinitis is a costly treatment, requiring prolonged hospitalization and carrying the risk of mortality. The main objective is to prevent the occurrence of mediastinitis. We believe that this objective should be pursued through a multidisciplinary approach involving cardiovascular surgery, infectious diseases, and plastic and reconstructive surgery units.

Kaynakça

  • 1. Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, et al. Mediastinitis and cardiac surgery-an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002;50:87-91. [Crossref]
  • 2. 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. [Crossref]
  • 3. 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. [Crossref]
  • 4. Bryan CS, Yarbrough WM. Prevention of deep wound infection after coronary artery bypass grafting: A review. Tex Heart Inst J 2013;40:125-39.
  • 5. El Oakley RM, Wright JE. Postoperative mediastinitis: Classification and management. Ann Thorac Surg 1996;61:1030. [Crossref]
  • 6. Okonta KE, Anbarasu M, Agarwai V, Jamesraj J, Kurian VM, Rajan S. Sternal wound in-fection following open heart surgery: Appraisal of incidence, risk factors, changing bacteriologic pattern and treatment outcome. Indian J Thorac Cardiovasc Surg 2011;27:28-32. [Crossref]
  • 7. Salehi Omran A, Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahedi Ni, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): Incidence, risk factors and mortality. BMC Infect Dis 2007;7:112. [Crossref]
  • 8. Sakamoto H, Fukuda I, Oosaka M, Nakata H. Risk factors and treatment of deep sternal wound infection after cardiac surgery. Ann Thorac Cardiovasc Surg 2003;9:226-32.
  • 9. Gårdlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg 2002;21:825-30. [Crossref]
  • 10. Schimmer C, Sommer SP, Bensch M, Leyh R. Primary treatment of deep sternal wound infection after cardiac surgery: A survey of German heart surgery centers. Interact Cardiovasc Thorac Surg 2007;6:708-11. [Crossref]
  • 11. Kubota H, Miyata H, Motomura N, Ono M, Takamoto S, Harii K, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg 2013;8:132. [Crossref]
  • 12. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth 2009;23:488-94. [Crossref]
  • 13. Nahai F, Rand RP, Hester TR, Bostwick J 3rd, Jurkiewicz MJ.Primary treatment of the infected sternotomy wound with muscle flaps: A review of 211 consecutive cases. Plast Reconstr Surg 1989;84:434-41. [Crossref]
  • 14. Greig AVH, Geh JLC, Khanduja V, Shibu M. Choice of flap fort he management of deep sternal wound infection an anatomical classification. J Plast Reconstr Aesthet Surg 2007;60:372-8. [Crossref]
  • 15. Şaşkın H, Düzyol Ç, Özcan KS, Maçika H, İdiz M. Açık kalp cerrahisi sonrası gelişen derin sternal enfeksiyonların tedavisinde vakum yardımlı kapama yönteminin etkinliği. Kocaeli Tıp Derg 2015;4;3:21-9.
  • 16. Sommerstein R, Kohler P, Wilhelm MJ, Kuster SP, Sax H. Factors associated with methicillin-resistant coagulase-negative staphylococci as causing organisms in deep sternal wound infections after cardiac surgery. New Microbes New Infect 2015;6:15-21. [Crossref]
  • 17. Parissis H, Al-Alao B, Soo A, Orr D, Young V. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition. J Cardiothorac Surg 2011;6:111. [Crossref]
  • 18. Bayraktar FA, Özhan A, Baştopçu M, Özhan HK, Taşdemir Mete EM. Results of negative pressure wound therapy for deep sternal wound infections after cardiac surgery. Cardiovasc Surg Int 2022;9:141-6. [Crossref]
  • 19. Hever P, Singh P, Eiben I, Eiben P, Nikkhah D. The management of deep sternal wound infection: Literature review and reconsturctive algorithm. JPRAS Open 2021;28:77-89. [Crossref]
  • 20. Aydın C, Başel H, Kara İ, Ay Y, Songur M, Yanartaş M, et al. Açık kalp cerrahisinden sonra derin sternum yara infeksiyonunda negatif basınçlı yara tedavisinin rolü. Koşuyolu Heart J 2012;16:115-9. [Crossref]
  • 21. Hämäläinen E, Laurikka J, Huhtala H, Järvinen O. Risk factors for 1-year mortality after postoperative deep sternal wound infection. Scandinavian J Surg 2023;112:41-47. [Crossref]
  • 22. Kachel E, Arazi M, Grosman-Rimon L, Yehezkeel S, Rimon J, Gohari J, et al. The modified sternoplasty: A novel surgical technique for treating mediastinitis. Plast Reconstr Surg Glob Open 2022;10:e4233. [Crossref]
  • 23. Davison SP, Clemens MW, Armstrong D, Newton ED, Swartz W. Sternotomy wounds: Rectus flap versus modified pectoral reconstruction. Plast Reconstr Surg 2007;120:929-34. [Crossref]
  • 24. Coltro PS, Farina Junior JA. The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence. J Card Surg 2022;37:2315-16. [Crossref]
  • 25. Elassal AA, Al-Ebrahim KE, Al-Radi OO, Jabbad HH, Eldib OS. Sternal wound complications: Objective reclassification and surgical reconsideration. Heart Surg Forum 2020;23:76-80. [Crossref]
Yıl 2023, Cilt: 26 Sayı: 2, 88 - 95, 12.07.2023

Öz

Kaynakça

  • 1. Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, et al. Mediastinitis and cardiac surgery-an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002;50:87-91. [Crossref]
  • 2. 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. [Crossref]
  • 3. 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. [Crossref]
  • 4. Bryan CS, Yarbrough WM. Prevention of deep wound infection after coronary artery bypass grafting: A review. Tex Heart Inst J 2013;40:125-39.
  • 5. El Oakley RM, Wright JE. Postoperative mediastinitis: Classification and management. Ann Thorac Surg 1996;61:1030. [Crossref]
  • 6. Okonta KE, Anbarasu M, Agarwai V, Jamesraj J, Kurian VM, Rajan S. Sternal wound in-fection following open heart surgery: Appraisal of incidence, risk factors, changing bacteriologic pattern and treatment outcome. Indian J Thorac Cardiovasc Surg 2011;27:28-32. [Crossref]
  • 7. Salehi Omran A, Karimi A, Ahmadi SH, Davoodi S, Marzban M, Movahedi Ni, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): Incidence, risk factors and mortality. BMC Infect Dis 2007;7:112. [Crossref]
  • 8. Sakamoto H, Fukuda I, Oosaka M, Nakata H. Risk factors and treatment of deep sternal wound infection after cardiac surgery. Ann Thorac Cardiovasc Surg 2003;9:226-32.
  • 9. Gårdlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg 2002;21:825-30. [Crossref]
  • 10. Schimmer C, Sommer SP, Bensch M, Leyh R. Primary treatment of deep sternal wound infection after cardiac surgery: A survey of German heart surgery centers. Interact Cardiovasc Thorac Surg 2007;6:708-11. [Crossref]
  • 11. Kubota H, Miyata H, Motomura N, Ono M, Takamoto S, Harii K, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg 2013;8:132. [Crossref]
  • 12. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth 2009;23:488-94. [Crossref]
  • 13. Nahai F, Rand RP, Hester TR, Bostwick J 3rd, Jurkiewicz MJ.Primary treatment of the infected sternotomy wound with muscle flaps: A review of 211 consecutive cases. Plast Reconstr Surg 1989;84:434-41. [Crossref]
  • 14. Greig AVH, Geh JLC, Khanduja V, Shibu M. Choice of flap fort he management of deep sternal wound infection an anatomical classification. J Plast Reconstr Aesthet Surg 2007;60:372-8. [Crossref]
  • 15. Şaşkın H, Düzyol Ç, Özcan KS, Maçika H, İdiz M. Açık kalp cerrahisi sonrası gelişen derin sternal enfeksiyonların tedavisinde vakum yardımlı kapama yönteminin etkinliği. Kocaeli Tıp Derg 2015;4;3:21-9.
  • 16. Sommerstein R, Kohler P, Wilhelm MJ, Kuster SP, Sax H. Factors associated with methicillin-resistant coagulase-negative staphylococci as causing organisms in deep sternal wound infections after cardiac surgery. New Microbes New Infect 2015;6:15-21. [Crossref]
  • 17. Parissis H, Al-Alao B, Soo A, Orr D, Young V. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition. J Cardiothorac Surg 2011;6:111. [Crossref]
  • 18. Bayraktar FA, Özhan A, Baştopçu M, Özhan HK, Taşdemir Mete EM. Results of negative pressure wound therapy for deep sternal wound infections after cardiac surgery. Cardiovasc Surg Int 2022;9:141-6. [Crossref]
  • 19. Hever P, Singh P, Eiben I, Eiben P, Nikkhah D. The management of deep sternal wound infection: Literature review and reconsturctive algorithm. JPRAS Open 2021;28:77-89. [Crossref]
  • 20. Aydın C, Başel H, Kara İ, Ay Y, Songur M, Yanartaş M, et al. Açık kalp cerrahisinden sonra derin sternum yara infeksiyonunda negatif basınçlı yara tedavisinin rolü. Koşuyolu Heart J 2012;16:115-9. [Crossref]
  • 21. Hämäläinen E, Laurikka J, Huhtala H, Järvinen O. Risk factors for 1-year mortality after postoperative deep sternal wound infection. Scandinavian J Surg 2023;112:41-47. [Crossref]
  • 22. Kachel E, Arazi M, Grosman-Rimon L, Yehezkeel S, Rimon J, Gohari J, et al. The modified sternoplasty: A novel surgical technique for treating mediastinitis. Plast Reconstr Surg Glob Open 2022;10:e4233. [Crossref]
  • 23. Davison SP, Clemens MW, Armstrong D, Newton ED, Swartz W. Sternotomy wounds: Rectus flap versus modified pectoral reconstruction. Plast Reconstr Surg 2007;120:929-34. [Crossref]
  • 24. Coltro PS, Farina Junior JA. The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence. J Card Surg 2022;37:2315-16. [Crossref]
  • 25. Elassal AA, Al-Ebrahim KE, Al-Radi OO, Jabbad HH, Eldib OS. Sternal wound complications: Objective reclassification and surgical reconsideration. Heart Surg Forum 2020;23:76-80. [Crossref]
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kardiyoloji
Bölüm Orijinal Araştırmalar
Yazarlar

Cengiz Ovalı Bu kişi benim 0000-0001-9371-8377

Alper Selim Kocaoğlu Bu kişi benim 0000-0003-2245-3775

Merve Nur Güçlüer Kocaoğlu Bu kişi benim 0009-0003-3452-1816

Atacan Emre Koçman Bu kişi benim 0000-0001-8196-1142

Yayımlanma Tarihi 12 Temmuz 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 26 Sayı: 2

Kaynak Göster

Vancouver Ovalı C, Kocaoğlu AS, Güçlüer Kocaoğlu MN, Koçman AE. Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal. 2023;26(2):88-95.