RADICAL DEBRIDEMENT AND OMENTAL TRANSPOSITION FOR POST STERNOTOMY MEDIASTINITIS

Objective: Reported mortality for postoperative mediastinitis treated by debridement alone can reach 40%. The authors' experience with radic al debridement and omental transposition is reviewed. Methods: Between May 1990 and August 1996, 14 patients with untractable mediastinitis had a transfer of the greater omentum: 11 after coronary artery bypass grafting (CABG) (6 bilateral internal thoracic arteries ITA grafts), one after a heart transplant, one after an aortic valve replacement an d CABG, and one after a repair of the aortic isthmus related to a moto r vehicle accident. The mean age was 63 +/- 8 years. Infection was pro ven in all patients by cultures of intraoperative specimens, Two patie nts had such a large sternal defect that no primary closure could be a ttempted, The remaining 12 patients had a mean of 1.4 +/- 0.7 previous debridement. Five patients had a total sternectomy. After radical deb ridement, the omentum was transferred over the entirety of the wound a nd covered with a meshed thin skin graft. All patients had a minimum o f 4 weeks of i.v. antibiotic therapy. Results: There was no operative death. Apart from one focal necrosis and one traumatic dehiscence of t he omentum, there was no hospital complication. Sepsis was controlled in all patients. The median hospital stay was 31 days (range 20-154 da ys), At a median follow-up of 20 months (range: 6-44 months), there we re two late deaths: one sudden and unexpected death and one after a re -do CABG. The remaining patients had resumed their previous activities . One patient had developed an incisional hernia and another underwent further surgery for cosmetic reasons. Conclusion: Radical debridement and omental transposition may achieve a cure for postoperative medias tinitis with good mid-term results. (C) 1998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All ri ghts reserved.