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Ann Thorac Surg 1988;46:45-46
© 1988 The Society of Thoracic Surgeons

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Articles

Management of Postoperative Mediastinitis in Infants and Children by Muscle Flap Rotation

Department of Surgery, Emory University School of Medicine and Henrietta Egleston Hospital for Children, Atlanta, GA

^* Address reprint requests to Dr. Sink, The Emory Clinic, 1365 Clifton Road, N.E., Atlanta, GA 30322

Between July 1, 1976, and June 30, 1986, at the Henrietta Egleston Hospital for Children, 2,242 infants and children underwent palliation or repair of a congenital heart defect. Twenty-one (0.94%) of these patients developed mediastinitis following a median sternotomy. Nineteen of these twenty-one patients had required cardiopulmonary bypass. All patients had positive mediastinal cultures.

The first 8 patients were managed traditionally by debridement and irrigation. Three of these patients suffered serious metabolic complications related to the povidone-iodine irrigant, which resulted in 1 death. Another patient died from persistent sepsis following debridement. Subsequently, 13 patients were managed by early debridement and rotation of the pectoralis major or rectus abdominis muscle flaps, or both. Following muscle flap rotation and early wound closure, 2 patients had subsequent incisional complications. One patient had incisional dehiscence and 1 had a superficial skin separation. Two deaths in this group, 28 and 51 days, respectively, following muscle flap rotation, resulted from nonincisional problems in patients with healed median sternotomies. The group having muscle flap rotation required a significantly shorter duration of postoperative ventilatory support (3.2 versus 24 days, p < 0.05) and a significantly shorter confinement in the intensive care unit (6.2 versus 33 days, p < 0.01). Also, the physiological and physical trauma of continued wound care in the awake child was minimized in the group with muscle flap rotation.

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