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Ann Thorac Surg 1998;66:602
© 1998 The Society of Thoracic Surgeons

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Correspondence

Sternal dehiscence in poststernotomy mediastinitis

^a Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Minami-Kawachi, Tochigi, 329-0498, Japan

To the Editor

I read with great interest the article by Bitkover and Grdlund [1] describing risk factors for postoperative mediastinitis. In their article, they referred to sternal instability as a possible risk factor for postoperative mediastinitis.

Our study [2] showed a high rate of sternal dehiscence in patients with postoperative mediastinitis. Eight of 11 patients with postoperative mediastinitis in our study had sternal dehiscence recognized by chest computed tomography, although none of 10 control patients had sternal dehiscence. Seven of the 8 patients also had a subcutaneous abscess that directly communicated with the mediastinum. However, 3 patients in whom apparent bacterial mediastinitis developed did not have sternal dehiscence.

Bitkover and Grdlund mentioned that the inward spread of bacteria from a subcutaneous region to the mediastinum might be a cause of sternal dehiscence. We respect their hypothesis, and their suggestion about possible risk factors causing postoperative mediastinitis should be minded by surgeons. In addition, we hypothesize that mediastinitis per se can also cause sternal dehiscence and subcutaneous abscess. In our 3 patients without sternal dehiscence, sternal dehiscence might have developed in the advanced stage. Sternal dehiscence in mediastinitis might not be a risk factor but a result.

References

1. Bitkover C.Y., Grdlund B. Mediastinitis after cardiac operations: a case-control study of risk factors. Ann Thorac Surg 1998;65:36-40.[Abstract/Free Full Text]
2. Misawa Y., Fuse K., Hasegawa T. Infectious mediastinitis after cardiac operations: computed tomographic findings. Ann Thorac Surg 1998;65:622-624.[Abstract/Free Full Text]

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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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshio Misawa Katsuo Fuse Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Misawa, Y. Articles by Fuse, K. Search for Related Content PubMed PubMed Citation Articles by Misawa, Y. Articles by Fuse, K.