Original Article

The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy

Abstract

Introduction: Mediastinitis is an important complication of open heart surgery and other thoracic operations. Deep sternal wound complications significantly increase morbidity and mortality. The best treatment for deep sternal wound following sternotomy is still under discussion. Repeated irrigation and debridement of the wound and closed chest catheter irrigation with the recent addition of plastic surgery approach such as pectoralis major flap transposition are all valid options with their own supporters.

Materials and Methods: Due to the high prevalence of deep sternal wound infection (DSWI), we conducted this retrospective descriptive study using existing information to compare conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results in a descriptive and analytic method. A total of 125 patient health record with deep sternal wound infection in a ten-year period (2003-2013) were evaluated.

Results: Results of this study proved that 83.2% of patients who developed DSWI after surgery, suffered from underlying diseases such as diabetes, renal failure, etc. though no relationship was found between the presence of underlying disease and recovery. Moreover, no significant relationship was observed between diabetes and recovery. Among 125 assessed files, 50 patients received pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. On the other hand, among cases without pectoralis flapping, only 67 patients’ records were available of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization; the recovery was significantly enhanced in the group receiving flapping. 

Discussion: The only factor which improved the outcome in our assessment was using pectoralis flapping which is consistent with the results of studies published in the recent years using plastic surgery methods, i.e. pectorals muscle or omentum flapping which is associated with high success rate and reduced length of in-patient stay

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IssueVol 7 No 2 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ajs.v7i2.16350
Keywords
mediastinitis median sternotomy pectoralis flapping
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How to Cite
1.
Pejhan S, Sadeghian E, Sheikhi K, Chakeri Yazdi M, Sadegh beigy F, Elyasinia F, Eslamian R, Mirsharifi AR. The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy. AJS. 2024;7(2):32-36.