Treatment of recurrent postoperative mediastinitis with granulated sugar

Background. The authors report their experience with granulated sugar as dr essing technique in the treatment of postoperative mediastinitis refractory to a closed irrigation system. Methods. Between January 1990 and January 1998, mediastinitis developed in 61 (0,93%) of 6521 patients who had undergone open heart surgery. Diagnosis of sternal infections was based on wound tenderness, drainage, cellulitis, fever associated with sternal instability. All of them were initially trea ted with surgical debridement and closed chest irrigation. Nine patients wi th postcardiotomy mediastinitis refractory to closed chest irrigation under went open dressing with granulated sugar. All of them were febrile with leu kocytosis and positive wound cultures. Results, Bacteria isolated were staphylococcus aureus in 6 cases, staphyloc occus epidermidis in 2 and pseudomonas in 1. Redebridement was performed in all cases and the wound was filled with granulated sugar four times a day. Fever ceased within 4.3+/-1.3 days from the beginning of treatment and WBC became normal after 6.6+/-1.6 days. Three patients had hyperbaric therapy as associated treatment. Complete wound healing was achieved In 58.8+/-32.9 days (three patients underwent successful pectoralis muscle flaps). Conclusions. Sugar treatment is a reasonable and effective option in patien ts with mediastinitis refractory to closed irrigation treatment. It may be used either as primary treatment or as a bridge to pectoralis muscle flaps.