The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy

Saviz Pejhan; Ehsan Sadeghian; Kambiz Sheikhi; Farahnaz Sadegh Beigy; Fezzeh Elyasinia; Reza Eslamian; Ali Reza Mirsharifi

doi:10.18502/ajs.v7i2.16350

Saviz Pejhan Associated Professor of Thoracic Surgery, LTRC.NRITLD, Shahid Beheshti University of Medical Sciences Tehran, Iran
Ehsan Sadeghian MD, General Surgeon, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Kambiz Sheikhi Associated Professor of Thoracic Surgery, LTRC.NRITLD, Shahid Beheshti University of Medical Sciences Tehran, Iran
Farahnaz Sadegh Beigy Associated Professor of Thoracic Surgery, LTRC.NRITLD, Shahid Beheshti University of Medical Sciences Tehran, Iran
Fezzeh Elyasinia Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Reza Eslamian Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ali Reza Mirsharifi Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ajs.v7i2.16350

Keywords: Mediastinitis, Median Sternotomy, Pectoralis Flapping

Abstract

Background: Mediastinitis is a significant complication of open heart surgery and other thoracic operations. Deep sternal wound complications notably increase morbidity and mortality. The optimal treatment for deep sternal wounds following sternotomy remains a topic of discussion. Options such as repeated irrigation and debridement of the wound, closed chest catheter irrigation, and recent plastic surgery approaches like pectoralis major flap transposition all have their proponents

Methods: Given the high prevalence of Deep Sternal Wound Infection (DSWI), we conducted this retrospective descriptive study. We used existing information to compare the conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results using descriptive and analytic methods. We evaluated a total of 125 patient health records with deep sternal wound infection over a ten-year period (2003-2013).

Results: The results of this study showed that 83.2% of patients who developed DSWI after surgery suffered from underlying diseases such as diabetes, renal failure, etc. However, no relationship was found between the presence of an underlying disease and recovery. Furthermore, no significant relationship was observed between diabetes and recovery. Among the 125 assessed files, 50 patients received a pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. Conversely, among cases without pectoralis flapping, records were available for only 67 patients, of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization. Recovery was significantly enhanced in the group receiving flapping.

Conclusions: The only factor that improved the outcome in our assessment was the use of pectoralis flapping. This is consistent with the results of studies published in recent years that used plastic surgery methods, i.e., pectorals muscle or omentum flapping, which are associated with a high success rate and reduced length of inpatient stay.