Treatment of Acute Sterno-Mediastinitis using Regional Muscle Flaps

ABSTRACT

Although the incidence of mediastinal wound infection after median sternotomy is relatively low, its associated devastating complications may be life-threatening. Treatment of sterno-mediastinal infection has evolved over the past several decades. Early treatment was wet soaking of debrided wound or irrigation through a closed indwelling catheter system and its mortality was quite high. Subsequent treatments focused on the debridement followed by muscle flaps such as pectoralis major and rectus abdominis muscle flap or by omental flap closure, which were considered as the ideal modalities for acute sterno-mediastinitis. Mortality rate was reduced significantly after application of this active treatment. However, to date, there has been no definite treatment strategy for sterno-mediastinitis and the choice of operations depends largely on the experience and personal preference of the surgeon. So we introduce our experience, including technique and outcome, with transposition of pectoralis major muscle and superiorly-based rectus abdominis muscle turn over flap for deep and extensive sterno-mediastinal wounds. Five patients(3 male and 2 female) had repair of an infected median sternotomy wound from July 2001 to september 2002. Complications after wound closure occured in 2 cases, 1 case of hematoma and 1 case of seroma, respectively. No other major complications have been noted. We treated MRSA or VRE- cultured acute sterno-mediastinitis successfully with early sternal wound debridement and immediate regional muscle flap coverage.