Management of Poststernotomy Mediastinitis: Experience and Results of Different Therapy Modalities

Abstract

As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V. A. C.(R) therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.

Risk Factors and Management Approach for Deep Sternal Wound Infection After Cardiac Surgery at a Tertiary Medical Centre

“…The frequency of this complication varies globally partly due to definitions used, however some centres have reported rates between 0.2% and 8% [5] and others ranging between 0.25% and 4% [6] of cardiac surgeries. In Australia, approximately 23,000 cardiac surgical procedures are conducted annually [7].…”

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

“…One of the life-threatening complications that occurs in patients following cardiovascular surgery through median sternotomy is deep sternal wound infection (DSWI). The incidence of DSWI that has been reported ranges from 0.2% to 8% (2,3). However, the mortality varies from 8% to 45%.…”

Sternal Wound Complications Following Cardiac Surgery

“…However, a consensus as to best treatment for mediastinal infection has yet to be established. For example, Schimmer et al recently surveyed 79 cardiac surgery programs in Germany to query DSWI management strategies [71]. They found that approximately 1/3 of the centers preferentially used NPT for controlling mediastinal contamination, while another 1/3 use closed chest irrigation, and another 1/3 combine management approaches [71].…”

“…For example, Schimmer et al recently surveyed 79 cardiac surgery programs in Germany to query DSWI management strategies [71]. They found that approximately 1/3 of the centers preferentially used NPT for controlling mediastinal contamination, while another 1/3 use closed chest irrigation, and another 1/3 combine management approaches [71]. Other groups continue to advocate more aggressive surgical therapy in addressing infected sternal wounds [7,72].…”