Intérêt de l’association VAC®-thérapie, ostéosynthèse sternale et lambeaux pectoraux d’avancement dans la prise en charge d’une médiastinite postopératoire après chirurgie cardiaque chez une obèse diabétique

BackgroundPost cardiac surgery mediastinitis is the major infectious complication, despite the development of surgical techniques and the application of strict preventive measures.The Haemophilus influenzae mediastinitis is very rare. The mediastinitis caused by the association between Haemophilus influenzae and Aggregatibacter aphrophilus has never been described to our knowledge.Case presentationWe report the case of an exceptional combination of Haemophilus influenzae and Aggregatibacter aphrophilus in a patient operated for single bypass which is complicated by mediastinitis the 10th day after the surgical act.ConclusionThe conclusion to be drawn from this work is to think in unusual seeds in case of mediastinitis post cardiac surgery for the elaboration of recommendations for antibiotic prophylaxis.

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“…Despite improved means of therapeutic treatment, morbidity and mortality remains high with a mortality rate ranging from 11 to 20% [3, 4]. …”

Section: Discussionmentioning

confidence: 99%

Exceptional association of two species of bacteria causing mediastinitis: Haemophilus influenzae (H. influenzae) and Aggregatibacter aphrophilus (A. aphrophilus)

et al. 2018

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“…The wound bed should be eradicated of any gross infection, for example, before foreign body material such as the titanium plating can be placed to prevent seeding and recurrence of infection. In such cases, it may be prudent to treat the infection with multiple surgical wash outs and debridement, vacuum assisted closure, and secondary ORIF once the infection appears to have subsided [18–21]. Furthermore, a stable solid sternal bony base is vital for the plate fixation.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction Internal Fixation Poststernotomy Mediastinitis

Sinno

Dionisopoulos

2013

Plastic Surgery International

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Introduction. Mediastinitis has been reported to complicate 5% of sternotomy surgery. We have adopted an open reduction and rigid internal fixation (ORIF) approach during the conventional rescue surgery in the treatment of mediastinitis. Methods. A retrospective review was performed to compare the outcomes of patients that had an ORIF to correct postoperative mediastinitis following median sternotomy. These were compared with the outcome of the patients that did not undergo ORIF. Results. In the 5-year study period, we reviewed 35 mediastinitis patient charts. Postoperatively, the ORIF patient group remained in the Intensive Care Unit (ICU) and on a ventilator for a mean of 1.5 and 0.75 days, respectively. Patients treated without ORIF spent significantly more days in the ICU (mean of 7.5 days, P < 0.05) and on a ventilator (mean of 2.15 days, P = 0.1). Furthermore, it was found that none of the patients (0%) who underwent ORIF complained of any postoperative sternal instability or pain. Preoperatively, however, these rates were as high as 72%. Conclusions. In the select patient, ORIF can be a safe option in the management of mediastinitis, which we have shown to significantly decrease morbidity and mortality by providing anatomic reduction as well as physiologic stabilization. We have shown that ORIF will improve the quality of life of the patient by minimizing abnormal sternal mobility and pain and will also decrease inpatient costs by decreasing days spent in the ICU and ventilator dependence.

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Giant Sternal Chondrosarcoma in a 50-Year-Old Patient

et al. 2022

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Chondrosarcomas represent approximately 20% of primary malignant bone cancers, being known as the most frequent neoplasia of the anterior thoracic wall. In our case, we present a case of a primary sternal chondrosarcoma in a 50-year-old female patient that has been polychemiotherapy and radiotherapy treated for breast cancer. Despite the initial treated malignancy of breast cancer in the personal pathologic history of the patient, it was discovered that the sternal tumor was not a metastatic disease from the breast neoplasm. After multiple investigations, the patient was successfully treated for the sternal chondrosarcoma after a radical sternal resection with a chest wall reconstruction completed with two titanium plates that were anchored on the ribs and with the placement of methyl methacrylate mesh.

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Intérêt de l’association VAC®-thérapie, ostéosynthèse sternale et lambeaux pectoraux d’avancement dans la prise en charge d’une médiastinite postopératoire après chirurgie cardiaque chez une obèse diabétique

Cited by 3 publications

References 21 publications

Exceptional association of two species of bacteria causing mediastinitis: Haemophilus influenzae (H. influenzae) and Aggregatibacter aphrophilus (A. aphrophilus)

Exceptional association of two species of bacteria causing mediastinitis: Haemophilus influenzae (H. influenzae) and Aggregatibacter aphrophilus (A. aphrophilus)

Open Reduction Internal Fixation Poststernotomy Mediastinitis

Giant Sternal Chondrosarcoma in a 50-Year-Old Patient

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