HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ahmed El Gamel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by El Gamel, A. Search for Related Content PubMed Articles by El Gamel, A.

Ann Thorac Surg 1998;66:296-297
© 1998 The Society of Thoracic Surgeons

---

Correspondence

Reply

^a Wythenshawe Hospital, Manchester, UK

To the Editor

My colleagues and I have been very strict with our policy in the hospital for methicillin-resistant Staphylococcus aureus. We isolate newly diagnosed cases and treat them until the infection is cleared. All staff have a regular microbiological check. I have no experience with methicillin-resistant Staphylococcus aureus in the setting of mediastinitis.

We do not use a separate incision to mobilize the pectoral muscle flaps. We also do not use this to fill the gap or dead space as there is no gap if the sternum is closed securely. The reasons for mobilizing muscle flaps are to relieve the sternum from lateral traction during pectoralis movement and to cover the bare sternum, providing a vascularized pedicle that is very good in resisting infection and assisting healing [1].

An omentum pedicle supplies excellent vascularized tissue to fill the infected pleural space and mediastinum and thereby help to control infection [2], particularly in patients with limited cardiopulmonary function. Our concern is that in sick patients with mediastinitis in the early phase, to use the omentum means exposing a second body cavity to the infecting organisms and reducing the respiratory reserve further in this particular group of patients. We do agree with Misawa and Fuse that later, when mediastinitis is proved to be under control, an elective plastic procedure using omental flaps is a very good treatment. We have no experience with this technique.

We thank Misawa and Fuse for their comments. We are eager to learn from their experience with methicillin-resistant Staphylococcus aureus mediastinitis.

References

1. Backer C.L., Pensler J.M., Tobin G.R., Mavroudis C. Vascularized muscle flaps for life-threatening mediastinal wounds in children. Ann Thorac Surg 1994;57:797-802.[Abstract/Free Full Text]
2. Stamatis G., Freitag L., Wencker M., Greschuchna D. Omentopexy and muscle transposition: two alternative methods in the treatment of pleural empyema and mediastinitis. Thorac Cardiovasc Surg 1994;42:225-232.[Medline]

This article has been cited by other articles:

				J. W. Hammon Extracorporeal Circulation: Perfusion System Card. Surg. Adult, January 1, 2008; 3(2008): 350 - 370. [Full Text]

				A. Combes, J.-L. Trouillet, J. Baudot, M. Mokhtari, J. Chastre, and C. Gibert Is it possible to cure mediastinitis in patients with major postcardiac surgery complications? Ann. Thorac. Surg., November 1, 2001; 72(5): 1592 - 1597. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ahmed El Gamel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by El Gamel, A. Search for Related Content PubMed Articles by El Gamel, A.