Ann Thorac Surg 2006;82:381-382
© 2006 The Society of Thoracic Surgeons
Correspondence
Deep Sternal Wound Infection After Cardiac Surgery
Yoshio Misawa, MD, PhD
Division of Cardiovascular Surgery, Jichi Medical School, Minamai-kawachi-shimotsuke, Tochigi, 329-0498 Japan
(Email: tcvmisa{at}jichi.ac.jp).
To the Editor:
I read with great interest Immer and colleagues' [1] article in which they showed an instructive strategy for treatment of deep sternal wound infection after cardiac surgery and outlined risk factors for treatment failure. Sternal infections greatly concern cardiac surgeons because of the clinical difficulties in diagnosis, treatment, and poor prognosis.Immer and colleagues [1] concluded that early diagnosis, aggressive surgical treatment by debridement, and the use of vacuum-assisted systems allowed them to achieve good long-term results with nearly normal quality of life. They also found that musculocutaneous flap transfer is a therapeutic option for high-risk patients. The vacuum-assisted system may function well for mediastinal drainage; however the system may not control an advanced infection because (except for inside the pericardium) the mediastinum does not have mesothelium, which has bactericidal activity. The authors also showed the limitations of the vacuum system in high-risk patients.
A musculocutaneous flap has a bactericidal activity [2], along with a mass effect that comes from occupying dead spaces in the infected mediastinum. These factors can contribute to the healing process of infected mediastinum. From the standpoint of the bactericidal activity, we prefer an omental transfer to that of a musculocutaneous flap [3–5]. However, a musculocutaneous flap transfer is our final optional strategy for treatment of a deep sternal infection; for example, candidates will be those who have undergone gastrectomy associated with omentectomy.
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References
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- Immer FF, Durrer M, Mühlemann KS, Erni D, Gahl B, Carrel TP. Deep sternal wound infection after cardiac surgerymodality of treatment and outcome. Ann Thorac Surg 2005;80:957-961.[Abstract/Free Full Text]
- El Gamel A, Yonan NA, Hassan R, et al. Treatment of mediastinitisearly modified Robicsek closure and pectoralis major advancement flaps. Ann Thorac Surg 1998;65:41-46.[Abstract/Free Full Text]
- Misawa Y, Fuse K. Muscle flap transfer or omental transfer for treatment of poststernotomy mediastinitis Ann Thorac Surg 1998;66:296-297.[Free Full Text]
- Oyama H, Misawa Y, Hasegawa N, Katoh M, Hasegawa T, Fuse K. A successful treatment of infective mediastinitis with chylomediastinitis after closure of atrial septal defect Kyoubu Geka 1994;47:864-865.
- Omura K, Misaki T, Takahashi H, Kobayashi K, Watanabe Y. Omental transfer for the treatment of sternal infection after cardiac surgeryreport of three cases. Jpn J Surg 1994;24:67-71.
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