[Clinical study on the diagnosis and treatment of retrosternal infection after median sternotomy].

From June 1964 to Dec. 1989, 1228 patients underwent cardiovascular operations by median sternotomy approach in our hospital. 18 of them (1.4%) were complicated by retrosternal infections and were treated successfully. Of these 18, 3 were treated by conservative method (Group 1), that is, local debridement and drainage. The other 15 were managed by a radical technique (Group 2) which includes reopening of the chest, radical debridement of retrosternal mediastinum, primary sternal reclosure and continuous retrosternal irrigation with antibiotic solutions. There was no hospital death. The mean healing time of the infected wounds was 91 days in Group 1, and 24 days in Group 2. Recurrence of wound infections was found in 2 cases in Group 1. Primary healing was obtained in all patients but 1 in Group 2 after initial debridement. The authors considered that (1) Early radical debridement with continuous irrigation is very effective for management of retrosternal infection; (2) Radical debridement should be done as early as the diagnosis of infection is established.