Oku T, Hira M, Sano S, Nakao K, Suma H, Takeuchi A
Nihon Kyobu Geka Gakkai Zasshi. 1989 Aug;37(8):1565-9.
Poststernotomy mediastinitis in 67-year-old female was successfully treated by early operation after coronary artery revascularization using bilateral internal mammary arteries and gastroepiploic artery. Wider debridement including sternum, ribs, mediastinal fat and connective tissues, and transfer of rt-pectoralis major muscle flap into the mediastinum to obliterate the dead space was performed. The sternal wound was primarily closed without postoperative irrigation. The sternum was stayed open without using any artificial substitute. In conclusion, the early diagnosis and operation is the key for successful treatment of poststernotomy mediastinitis. Wider debridement including sternum and ribs with perioperative lavage by diluted povidone-iodine solution and antibiotic solution should be done aggressively, and the transfer of the major pectoral muscle flap and skin closure without postoperative irrigation is an effective method of choice. Additional reconstruction of anterior chest wall should be considered if necessary, when the inflammatory process is subsided.
