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Ann Thorac Surg 1998;66:602-603
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Departments of Thoracic Surgery and Infectious Diseases, Karolinska Hospital, S-171 76 Stockholm, Sweden, e-mail: catarina.bitkover@thxkir.ks.se, bengt.gardlund@mb.ks.se

To the Editor

We thank Drs Misawa and Fuse for their comment on our article [1]. It seems that dehiscence (disruption of stable fixation of the sternotomy) is associated with an increased risk of mediastinitis. There are two alternative explanations for this: (1) dehiscence and rupture of the mechanical barrier permits the inward spread of an otherwise banal subcutaneous presternal infection or (2) a primary retrosternally located infection involves the sternum and hinders bone healing. Our study favors the former interpretation because obesity and symptoms of obstructive lung disease, which may result in excessive strain of the sternal wiring, were found to be strong risk factors for mediastinitis [1].

Several investigators seem to agree that obliteration of tissue planes in the retrosternal compartment has the highest diagnostic value in mediastinitis [2–4]. Traditional signs of dehiscence can be found on clinical examination as an instability of the sternotomy, or perhaps on a plain chest film as movement of sternal wires relative to each other. Using computed tomographic scanning, several investigators have noted that sternal imperfections in the form of compression, step-offs, or frank gaps up to 8 mm are common in postoperative patients with an uneventful recovery [2, 3]. Sternal imperfections are therefore of very limited diagnostic weight. We have found that the clinical findings and computed tomographic results correlate poorly and that computed tomography as used in our hospital is a very poor tool for diagnosing mediastinitis (manuscript in preparation). We are certainly looking forward to sharing Misawa and associates’ data.

References

1. Bitkover C.Y., Gårdlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998;65:36-40.[Abstract/Free Full Text]
2. Goodman L.R., Kay H.R., Teplick S.K., Mundth E.D. Complications of median sternotomy: computed tomography evaluation. AJR 1983;141:225-230.[Abstract/Free Full Text]
3. Kay H.R., Goodman L.R., Teplick S.K., Mundth E.D. Use of computed tomography to assess mediastinal complications after median sternotomy. Ann Thorac Surg 1983;36:706-714.[Abstract]
4. Breatnach E., Nath P.H., Delany D.J. The role of computed tomography in acute and subacute mediastinitis. Clin Radiol 1986;37:139-145.[Medline]

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): Catarina Y. Bitkover Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bitkover, C. Y. Articles by Gårdlund, B. Search for Related Content PubMed Articles by Bitkover, C. Y. Articles by Gårdlund, B.