POSTOPERATIVE MEDIASTINITIS - CLASSIFICATION AND MANAGEMENT

Although the incidence of mediastinal wound infection in patients unde rgoing median sternotomy for cardiopulmonary bypass is less than 1%, i ts associated morbidity, mortality, and ''cost'' remain unacceptably h igh. There is considerable lack of consensus regarding the ideal opera tive treatment of complicated median sternotomy wounds. The aim of thi s article is to review the current preventive, diagnostic, and therape utic techniques offered to patients with mediastinitis. We also propos e a new classification for postoperative mediastinitis. Data from the English-language literature suggest that the type of mediastinitis and direct assessment of the mediastinum under general anesthesia are the main determinants of the nature of subsequent operative treatment. Wo und debridement and removal of foreign materials are essential steps o f whatever procedures are applied. Closed mediastinal irrigation can b e successful in type I mediastinitis, whereas major reconstructive ope ration is probably the treatment of choice for patients with mediastin itis types II to V. Refinement of the current diagnostic tools and fur ther evaluation of the benefits of primary sternal fixation in combina tion with a reconstructive procedure in mediastinitis types I to III c ould improve the outcome of this dreaded complication.