Evolution in the treatment of mediastinitis: single-center experience
This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In gro...
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| Veröffentlicht in: | Asian cardiovascular & thoracic annals 2011-02, Vol.19 (1), p.39-43 |
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| creator | Feo, Marisa De Vicchio, Mariano Santè, Pasquale Cerasuolo, Flavio Nappi, Gianantonio |
| description | This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979–1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995–2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002–2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate. |
| doi_str_mv | 10.1177/0218492310395789 |
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Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979–1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995–2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002–2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. 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Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979–1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995–2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002–2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate.</description><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bandages</subject><subject>Chi-Square Distribution</subject><subject>Combined Modality Therapy</subject><subject>Debridement</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hyperbaric Oxygenation</subject><subject>Italy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Mediastinitis - etiology</subject><subject>Mediastinitis - mortality</subject><subject>Mediastinitis - therapy</subject><subject>Middle Aged</subject><subject>Negative-Pressure Wound Therapy</subject><subject>Pectoralis Muscles - surgery</subject><subject>Reoperation</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sternotomy - adverse effects</subject><subject>Sternotomy - mortality</subject><subject>Surgical Flaps</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - mortality</subject><subject>Surgical Wound Infection - therapy</subject><subject>Therapeutic Irrigation</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Wound Healing</subject><issn>0218-4923</issn><issn>1816-5370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAYhC0EoqWwM6FsTAF_xLHNhqryIVVigTlynNfFVeIU20Hw75uqhQGJ6YZ77qQ7hC4JviFEiFtMiSwUZQQzxYVUR2hKJClzzgQ-RtOdne_8CTqLcY0xZoTJUzShhHHBSDlFi8Vn3w7J9T5zPkvvkKUAOnXgU9bbrIPG6Zicd8nFuyw6v2ohN6MLIYOvDQQH3sA5OrG6jXBx0Bl6e1i8zp_y5cvj8_x-mRvKScqNtgzqhpWNakppBFdQK0wotaTQlEvDrcC6YFYxTpmtiaK15rxWIGthSsVm6Hrfuwn9xwAxVZ2LBtpWe-iHWEle8LLAJR5JvCdN6GMMYKtNcJ0O3xXB1e676u93Y-TqUD7U4-7fwM9ZI5DvgahXUK37Ifhx7P-FWxpodm4</recordid><startdate>201102</startdate><enddate>201102</enddate><creator>Feo, Marisa De</creator><creator>Vicchio, Mariano</creator><creator>Santè, Pasquale</creator><creator>Cerasuolo, Flavio</creator><creator>Nappi, Gianantonio</creator><general>SAGE Publications</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>201102</creationdate><title>Evolution in the treatment of mediastinitis: single-center experience</title><author>Feo, Marisa De ; Vicchio, Mariano ; Santè, Pasquale ; Cerasuolo, Flavio ; Nappi, Gianantonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c251t-caf3ebd36d9d68c759eb90122f14a258c5f70a43f93523fb192ba55b9e8b7c693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bandages</topic><topic>Chi-Square Distribution</topic><topic>Combined Modality Therapy</topic><topic>Debridement</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hyperbaric Oxygenation</topic><topic>Italy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Mediastinitis - etiology</topic><topic>Mediastinitis - mortality</topic><topic>Mediastinitis - therapy</topic><topic>Middle Aged</topic><topic>Negative-Pressure Wound Therapy</topic><topic>Pectoralis Muscles - surgery</topic><topic>Reoperation</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sternotomy - adverse effects</topic><topic>Sternotomy - mortality</topic><topic>Surgical Flaps</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - mortality</topic><topic>Surgical Wound Infection - therapy</topic><topic>Therapeutic Irrigation</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Wound Healing</topic><toplevel>online_resources</toplevel><creatorcontrib>Feo, Marisa De</creatorcontrib><creatorcontrib>Vicchio, Mariano</creatorcontrib><creatorcontrib>Santè, Pasquale</creatorcontrib><creatorcontrib>Cerasuolo, Flavio</creatorcontrib><creatorcontrib>Nappi, Gianantonio</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>Asian cardiovascular & thoracic annals</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feo, Marisa De</au><au>Vicchio, Mariano</au><au>Santè, Pasquale</au><au>Cerasuolo, Flavio</au><au>Nappi, Gianantonio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolution in the treatment of mediastinitis: single-center experience</atitle><jtitle>Asian cardiovascular & thoracic annals</jtitle><addtitle>Asian Cardiovasc Thorac Ann</addtitle><date>2011-02</date><risdate>2011</risdate><volume>19</volume><issue>1</issue><spage>39</spage><epage>43</epage><pages>39-43</pages><issn>0218-4923</issn><eissn>1816-5370</eissn><abstract>This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979–1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995–2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002–2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>21357316</pmid><doi>10.1177/0218492310395789</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Anti-Bacterial Agents - therapeutic use Bandages Chi-Square Distribution Combined Modality Therapy Debridement Female Hospital Mortality Humans Hyperbaric Oxygenation Italy Length of Stay Male Mediastinitis - etiology Mediastinitis - mortality Mediastinitis - therapy Middle Aged Negative-Pressure Wound Therapy Pectoralis Muscles - surgery Reoperation Risk Assessment Risk Factors Sternotomy - adverse effects Sternotomy - mortality Surgical Flaps Surgical Wound Infection - etiology Surgical Wound Infection - mortality Surgical Wound Infection - therapy Therapeutic Irrigation Time Factors Treatment Outcome Wound Healing |
| title | Evolution in the treatment of mediastinitis: single-center experience |
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