Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery
Purpose To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis. Methods Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated...
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| Veröffentlicht in: | Surgery today (Tokyo, Japan) Japan), 2009-11, Vol.39 (11), p.947-954 |
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| container_title | Surgery today (Tokyo, Japan) |
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| creator | Eyileten, Zeynep Akar, Ahmet Ruchan Eryilmaz, Sadik Sirlak, Mustafa Yazicioglu, Levent Durdu, Serkan Uysalel, Adnan Ozyurda, Umit |
| description | Purpose
To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.
Methods
Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 ± 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 ± 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.
Results
The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 ± 10.8 days (range 5–62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (
P
= 0.046). Hospital mortality after treatment was 4.6% (
n
= 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant
Staphylococcus aureus
(MRSA;
n
= 2) and
Acinetobacter
species (
n
= 1). The median hospital stay was 29 days (range 15–110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.
Conclusions
Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity. |
| doi_str_mv | 10.1007/s00595-008-3982-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_734121970</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>734121970</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-f5d9af80742482f5992213a1f0eb824436347f68a7c4d06f3c63495ea61ecb143</originalsourceid><addsrcrecordid>eNp9kEtrHDEQhEVwiDdOfkAuRjeflLQeMyMdg3EesJBLkqvQalpGZh5rteaw_z4yu5CbT920qgrVx9gnCZ8lwPCFADrXCQArtLNKdG_YThrdC2WlvmI7cEYKqZy8Zu-JngCUsQDv2LV01iot-x07_Q1x22YRiDJVHHmcVtoK8rCM_JCnULGEiR8x1rUtmfi8UZyQpykciae18DGnhAWXyqmGRyS-Jj7jmAPVvOTaLCG1FB5DacfIW_wjltMH9jaFifDjZd6wP98eft__EPtf33_ef92LaLStInWjC8nCYNrnVeqcU0rqIBPgwSrT2mozpN6GIZoR-qRjO7gOQy8xHhqNG3Z3zj2W9XlDqn7OFHGawoLrRn7QRirpBmhKeVbGshIVTP5Y8hzKyUvwL8D9GbhvwP0LcN81z-0lfTu00v8dF8JNoM4Cak9LK-6f1q0srfErqf8AZfaNbA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>734121970</pqid></control><display><type>article</type><title>Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Eyileten, Zeynep ; Akar, Ahmet Ruchan ; Eryilmaz, Sadik ; Sirlak, Mustafa ; Yazicioglu, Levent ; Durdu, Serkan ; Uysalel, Adnan ; Ozyurda, Umit</creator><creatorcontrib>Eyileten, Zeynep ; Akar, Ahmet Ruchan ; Eryilmaz, Sadik ; Sirlak, Mustafa ; Yazicioglu, Levent ; Durdu, Serkan ; Uysalel, Adnan ; Ozyurda, Umit</creatorcontrib><description>Purpose
To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.
Methods
Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 ± 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 ± 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.
Results
The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 ± 10.8 days (range 5–62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (
P
= 0.046). Hospital mortality after treatment was 4.6% (
n
= 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant
Staphylococcus aureus
(MRSA;
n
= 2) and
Acinetobacter
species (
n
= 1). The median hospital stay was 29 days (range 15–110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.
Conclusions
Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.</description><identifier>ISSN: 0941-1291</identifier><identifier>EISSN: 1436-2813</identifier><identifier>DOI: 10.1007/s00595-008-3982-5</identifier><identifier>PMID: 19882316</identifier><language>eng</language><publisher>Japan: Springer Japan</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiac Surgical Procedures - methods ; Female ; Follow-Up Studies ; Humans ; Male ; Mediastinitis - pathology ; Mediastinitis - surgery ; Medicine ; Medicine & Public Health ; Middle Aged ; Negative-Pressure Wound Therapy - methods ; Original Article ; Pectoralis Muscles - transplantation ; Retrospective Studies ; Sternotomy ; Surgery ; Surgical Flaps ; Surgical Oncology ; Surgical Wound Dehiscence - pathology ; Surgical Wound Dehiscence - therapy ; Treatment Outcome</subject><ispartof>Surgery today (Tokyo, Japan), 2009-11, Vol.39 (11), p.947-954</ispartof><rights>Springer 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-f5d9af80742482f5992213a1f0eb824436347f68a7c4d06f3c63495ea61ecb143</citedby><cites>FETCH-LOGICAL-c438t-f5d9af80742482f5992213a1f0eb824436347f68a7c4d06f3c63495ea61ecb143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00595-008-3982-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00595-008-3982-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19882316$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eyileten, Zeynep</creatorcontrib><creatorcontrib>Akar, Ahmet Ruchan</creatorcontrib><creatorcontrib>Eryilmaz, Sadik</creatorcontrib><creatorcontrib>Sirlak, Mustafa</creatorcontrib><creatorcontrib>Yazicioglu, Levent</creatorcontrib><creatorcontrib>Durdu, Serkan</creatorcontrib><creatorcontrib>Uysalel, Adnan</creatorcontrib><creatorcontrib>Ozyurda, Umit</creatorcontrib><title>Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery</title><title>Surgery today (Tokyo, Japan)</title><addtitle>Surg Today</addtitle><addtitle>Surg Today</addtitle><description>Purpose
To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.
Methods
Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 ± 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 ± 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.
Results
The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 ± 10.8 days (range 5–62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (
P
= 0.046). Hospital mortality after treatment was 4.6% (
n
= 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant
Staphylococcus aureus
(MRSA;
n
= 2) and
Acinetobacter
species (
n
= 1). The median hospital stay was 29 days (range 15–110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.
Conclusions
Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Mediastinitis - pathology</subject><subject>Mediastinitis - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Negative-Pressure Wound Therapy - methods</subject><subject>Original Article</subject><subject>Pectoralis Muscles - transplantation</subject><subject>Retrospective Studies</subject><subject>Sternotomy</subject><subject>Surgery</subject><subject>Surgical Flaps</subject><subject>Surgical Oncology</subject><subject>Surgical Wound Dehiscence - pathology</subject><subject>Surgical Wound Dehiscence - therapy</subject><subject>Treatment Outcome</subject><issn>0941-1291</issn><issn>1436-2813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtrHDEQhEVwiDdOfkAuRjeflLQeMyMdg3EesJBLkqvQalpGZh5rteaw_z4yu5CbT920qgrVx9gnCZ8lwPCFADrXCQArtLNKdG_YThrdC2WlvmI7cEYKqZy8Zu-JngCUsQDv2LV01iot-x07_Q1x22YRiDJVHHmcVtoK8rCM_JCnULGEiR8x1rUtmfi8UZyQpykciae18DGnhAWXyqmGRyS-Jj7jmAPVvOTaLCG1FB5DacfIW_wjltMH9jaFifDjZd6wP98eft__EPtf33_ef92LaLStInWjC8nCYNrnVeqcU0rqIBPgwSrT2mozpN6GIZoR-qRjO7gOQy8xHhqNG3Z3zj2W9XlDqn7OFHGawoLrRn7QRirpBmhKeVbGshIVTP5Y8hzKyUvwL8D9GbhvwP0LcN81z-0lfTu00v8dF8JNoM4Cak9LK-6f1q0srfErqf8AZfaNbA</recordid><startdate>20091101</startdate><enddate>20091101</enddate><creator>Eyileten, Zeynep</creator><creator>Akar, Ahmet Ruchan</creator><creator>Eryilmaz, Sadik</creator><creator>Sirlak, Mustafa</creator><creator>Yazicioglu, Levent</creator><creator>Durdu, Serkan</creator><creator>Uysalel, Adnan</creator><creator>Ozyurda, Umit</creator><general>Springer Japan</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20091101</creationdate><title>Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery</title><author>Eyileten, Zeynep ; Akar, Ahmet Ruchan ; Eryilmaz, Sadik ; Sirlak, Mustafa ; Yazicioglu, Levent ; Durdu, Serkan ; Uysalel, Adnan ; Ozyurda, Umit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-f5d9af80742482f5992213a1f0eb824436347f68a7c4d06f3c63495ea61ecb143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Mediastinitis - pathology</topic><topic>Mediastinitis - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Negative-Pressure Wound Therapy - methods</topic><topic>Original Article</topic><topic>Pectoralis Muscles - transplantation</topic><topic>Retrospective Studies</topic><topic>Sternotomy</topic><topic>Surgery</topic><topic>Surgical Flaps</topic><topic>Surgical Oncology</topic><topic>Surgical Wound Dehiscence - pathology</topic><topic>Surgical Wound Dehiscence - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eyileten, Zeynep</creatorcontrib><creatorcontrib>Akar, Ahmet Ruchan</creatorcontrib><creatorcontrib>Eryilmaz, Sadik</creatorcontrib><creatorcontrib>Sirlak, Mustafa</creatorcontrib><creatorcontrib>Yazicioglu, Levent</creatorcontrib><creatorcontrib>Durdu, Serkan</creatorcontrib><creatorcontrib>Uysalel, Adnan</creatorcontrib><creatorcontrib>Ozyurda, Umit</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery today (Tokyo, Japan)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eyileten, Zeynep</au><au>Akar, Ahmet Ruchan</au><au>Eryilmaz, Sadik</au><au>Sirlak, Mustafa</au><au>Yazicioglu, Levent</au><au>Durdu, Serkan</au><au>Uysalel, Adnan</au><au>Ozyurda, Umit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery</atitle><jtitle>Surgery today (Tokyo, Japan)</jtitle><stitle>Surg Today</stitle><addtitle>Surg Today</addtitle><date>2009-11-01</date><risdate>2009</risdate><volume>39</volume><issue>11</issue><spage>947</spage><epage>954</epage><pages>947-954</pages><issn>0941-1291</issn><eissn>1436-2813</eissn><abstract>Purpose
To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.
Methods
Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 ± 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 ± 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.
Results
The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 ± 10.8 days (range 5–62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (
P
= 0.046). Hospital mortality after treatment was 4.6% (
n
= 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant
Staphylococcus aureus
(MRSA;
n
= 2) and
Acinetobacter
species (
n
= 1). The median hospital stay was 29 days (range 15–110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.
Conclusions
Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.</abstract><cop>Japan</cop><pub>Springer Japan</pub><pmid>19882316</pmid><doi>10.1007/s00595-008-3982-5</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0941-1291 |
| ispartof | Surgery today (Tokyo, Japan), 2009-11, Vol.39 (11), p.947-954 |
| issn | 0941-1291 1436-2813 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_734121970 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adult Aged Aged, 80 and over Cardiac Surgical Procedures - methods Female Follow-Up Studies Humans Male Mediastinitis - pathology Mediastinitis - surgery Medicine Medicine & Public Health Middle Aged Negative-Pressure Wound Therapy - methods Original Article Pectoralis Muscles - transplantation Retrospective Studies Sternotomy Surgery Surgical Flaps Surgical Oncology Surgical Wound Dehiscence - pathology Surgical Wound Dehiscence - therapy Treatment Outcome |
| title | Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery |
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