Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap

Authors : Cengiz OVALI, Alper Selim KOCAOĞLU, Merve Nur GÜÇLÜER KOCAOĞLU, Atacan Emre KOÇMAN

Pages : 88-95

View : 19 | Download : 53

Publication Date : 2023-07-12

Article Type : Research Paper

Abstract :Introduction: Mediastinitis is a rare occurrence following cardiac surgeries; however, it is a significant cause of both mortality and morbidity. Given the significance of mediastinal infections, early diagnosis, and treatment become of paramount importance. The management of this condition necessitates a multidisciplinary approach, involving collaboration and coordination among various medical specialties. Patients and Methods: 21 patients with a diagnosis of deep mediastinal infection who were treated at Eskişehir Osmangazi University Medical Faculty Hospital between January 2015 and May 2021 were included in the study. Broad-spectrum antibiotic therapy, serial debridement, and vacuum-assisted closure were applied to all patients. Among the patients who exhibited negative blood cultures and developed granulation tissue, those with tissue losses that did not extend to the sternum incision sites were assessed for potential flap procedures in conjunction with plastic and reconstructive surgery. In such cases, closure of the wound was achieved using a pectoral muscle flap. All patients were followed for one year. Results: Among the patients, 14 insert ignore into journalissuearticles values(66.6%); were female and seven insert ignore into journalissuearticles values(33.3%); were male, with a mean age of 62.7 ± 6.5 insert ignore into journalissuearticles values(range: 41-76 years);. Three of the 21 patients included in the study had type I, two had type II, and 16 had type IIIA mediastinitis. Staphylococcus aureus insert ignore into journalissuearticles values(S. aureus); was the most commonly isolated microorganism with 11 patients insert ignore into journalissuearticles values(52.3%);. The right pectoralis major muscle was used in four patients insert ignore into journalissuearticles values(19%);, the left pectoralis major muscle in four patients insert ignore into journalissuearticles values(19%);, and the bilateral pectoralis major muscle in 13 patients insert ignore into journalissuearticles values(62%);. There was no need for re-intervention in the follow-up of the patients. No mortality because of infection, surgical muscle flap closure, and/or cardiac causes was observed in any of the patients who were treated. Conclusion: Mediastinitis is a costly treatment, requiring prolonged hospitalization and carrying the risk of mortality. The main objective is to prevent the occurrence of mediastinitis. We believe that this objective should be pursued through a multidisciplinary approach involving cardiovascular surgery, infectious diseases, and plastic and reconstructive surgery units.
Keywords : Mediastinitis, debridement, pectoralis flap