A rational approach to wound difficulties after sternotomy: The problem

One hundred fifty-one patients with mediastinitis after median sternotomy w ere treated by a single surgeon over a 6-year period. The infections were a nalyzed in regard to the depth of infection, time of presentation, and the mediastinal defect. Preoperative evaluations included computed tomographic (CT) scans, testing for sternal stability, and the level of contamination. Intraoperative evaluations included bone, inflammatory tissues, Gram stain, and cultures. Treatment options included rewire procedures (20 patients), immediate reconstruction (63 patients), or delayed reconstructions (88 pati ents). The issues of exposed prosthetic material, right ventricular lacerat ion, long-term intravenous antibiotics, Candida infections, and reexplorati on of the healed mediastinum, after flap reconstruction are discussed. The overall approach to postoperative healing difficulties after sternotomy is examined. (C) 2001 by The Society of Thoracic Surgeons.