OPTIONS FOR THE MANAGEMENT OF POSTSTERNOTOMY MEDIASTINITIS

The management of 27 consecutive deep sternotomy wound infections is r eviewed. In 22 cases the initial treatment was debridement, sternal re fixation and dilute antibiotic irrigation via multiple irrigation-suct ion catheters. In the nine cases (41%) in which these measures failed, more extensive sternal and costal cartilage debridement and closure w ith a muscle flap were performed. Five cases were initially managed wi th major reconstructive surgery. For reconstruction, a bilateral pecto ralis major myocutaneous flap was used alone in eight cases, while in six the flap was insufficient to obliterate the whole poststernectomy space, and was supplemented with rectus abdominis muscle. Early medias tinitis can be effectively treated with thorough wound debridement and mediastinal irrigation, but if there is a two-week delay from the ini tial sternotomy to manifestation of infection, radical debridement wit h muscle flap closure should be seriously considered.