Vascularized Muscle Flap Transposition Combined with Negative Pressure Wound Therapy for the Treatment of Complicated Mediastinitis after Cardiac Surgery in One-stage_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CAOXiang-rong , ZHANGFu-en , SUNGuang-long , LIJi-yong , ZHANGJian-qun

Department of Cardiac Surgery, Beijing Institute of Heart Lung and Blood Vessel Disease & Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

CAOXiang-rong, Email: doccxr@126.com

Keywords：

Mediastinitis; Cardiac surgery; Pectoralis major muscle flap; Negative pressure wound therapy; One-stage reconstruction

DOI：

10.7507/1007-4848.20140102

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Objective To summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. Methods Clinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy (NPWT)for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. Results Postoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. Conclusion Vascularized muscle flap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.

Citation： CAOXiang-rong, ZHANGFu-en, SUNGuang-long, LIJi-yong, ZHANGJian-qun. Vascularized Muscle Flap Transposition Combined with Negative Pressure Wound Therapy for the Treatment of Complicated Mediastinitis after Cardiac Surgery in One-stage. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 371-374. doi: 10.7507/1007-4848.20140102 Copy

1.	Saso S, James D, Vecht JA, et al. Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection. Ann Thorac Surg, 2010, 89 (2):661-670.
2.	Loop FD, Lytle BW, Cosgrove DM, et al. Sternal wound complications after isolated coronary artery bypass grafting:early and late mortality, morbidity, and cost of care. Ann Thorac Surg, 1990, 49 (2):179-186.
3.	Cheung EH, Craver JM, Jones EL, et al. Mediastinitis after cardiac valve operations. Impact upon survival. J Thorac Cardiovasc Surg, 1985, 90 (4):517-522.
4.	El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg, 1996, 61 (3):1030-1036.
5.	Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg, 1999, 67 (2):462-465.
6.	Niclauss L, Delay D, Stumpe F, et al. Right ventricular rupture due to recurrent mediastinal infection with a closed chest. Interact Cardiovasc Thorac Surg, 2010, 10 (3):470-472.
7.	Das S, Rubio A, Simsic JM, et al. Bloodstream infections increased after delayed sternal closure:cause or coincidence. Ann Thorac Surg, 2011, 91 (3):793-797.
8.	Jurkiewicz MJ, Bostwick J 3rd, Hester TR, et al. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg, 1980, 191 (6):738-744.
9.	Lee AB Jr, Schimert G, Shaktin S, et al. Total excision of the ster-num and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery, 1976, 80 (4):433-436.
10.	Milano CA, Georgiade G, Muhlbaier LH, et al. Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann Thorac Surg, 1999, 67 (2):377-380.
11.	Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infe-cted median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg, 1997, 225 (6):766-776.
12.	Argenta LC, Morykwas MJ. Vacuum-assisted closure:a new method for wound control and treatment:clinical experience. Ann Plast Surg, 1997, 38:563-576.
13.	De Brabandere K, Jacobs-Tulleneers-Thevissen D, Czapla J, et al. Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy. Tex HeartInst J, 2012, 39 (3):367-371.
14.	Wong CH, Senewiratne S, Garlick B, et al. Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap. Eur J Cardiothorac Surg, 2006, 30 (1):148-152.
15.	Bejko J, Tarzia V, De Franceschi M, et al. Nitinol flexigrip sternal closure system and chest wound infections:insight from a comparative analysis of complications and costs. Ann Thorac Surg, 2012, 94 (6):1848-1853.
16.	Gucu A, Toktas F, Eris C, et al. Nitinol thermoreactive clips for secondary sternal closure in cases of noninfective sternal dehiscence. Tex Heart Inst J, 2012, 39 (4):513-516.
17.	Levin LS, Miller AS, Gajjar AH, et al. An innovative approach for sternal closure. Ann Thorac Surg, 2010, 89 (6):1995-1999.
18.	刘伟, 余国祥, 樊汉利, 等.胸大肌瓣移植在慢性胸骨骨髓炎治疗中的应用.中国胸心血管外科临床杂志, 2002, 9 (4):285.
19.	孙广龙, 曹向戎, 张健群.双侧胸大肌内侧头转移术治疗心脏术后胸骨哆开.中国胸心血管外科临床杂志, 2013, 20 (2):185-187.
20.	Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg, 2002, 21 (5):825-830.
21.	Tegnell A, Aren C, Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg, 2000, 69 (4):1104-1109.

1. Saso S, James D, Vecht JA, et al. Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection. Ann Thorac Surg, 2010, 89 (2):661-670.
2. Loop FD, Lytle BW, Cosgrove DM, et al. Sternal wound complications after isolated coronary artery bypass grafting:early and late mortality, morbidity, and cost of care. Ann Thorac Surg, 1990, 49 (2):179-186.
3. Cheung EH, Craver JM, Jones EL, et al. Mediastinitis after cardiac valve operations. Impact upon survival. J Thorac Cardiovasc Surg, 1985, 90 (4):517-522.
4. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg, 1996, 61 (3):1030-1036.
5. Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg, 1999, 67 (2):462-465.
6. Niclauss L, Delay D, Stumpe F, et al. Right ventricular rupture due to recurrent mediastinal infection with a closed chest. Interact Cardiovasc Thorac Surg, 2010, 10 (3):470-472.
7. Das S, Rubio A, Simsic JM, et al. Bloodstream infections increased after delayed sternal closure:cause or coincidence. Ann Thorac Surg, 2011, 91 (3):793-797.
8. Jurkiewicz MJ, Bostwick J 3rd, Hester TR, et al. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg, 1980, 191 (6):738-744.
9. Lee AB Jr, Schimert G, Shaktin S, et al. Total excision of the ster-num and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery, 1976, 80 (4):433-436.
10. Milano CA, Georgiade G, Muhlbaier LH, et al. Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann Thorac Surg, 1999, 67 (2):377-380.
11. Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infe-cted median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg, 1997, 225 (6):766-776.
12. Argenta LC, Morykwas MJ. Vacuum-assisted closure:a new method for wound control and treatment:clinical experience. Ann Plast Surg, 1997, 38:563-576.
13. De Brabandere K, Jacobs-Tulleneers-Thevissen D, Czapla J, et al. Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy. Tex HeartInst J, 2012, 39 (3):367-371.
14. Wong CH, Senewiratne S, Garlick B, et al. Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap. Eur J Cardiothorac Surg, 2006, 30 (1):148-152.
15. Bejko J, Tarzia V, De Franceschi M, et al. Nitinol flexigrip sternal closure system and chest wound infections:insight from a comparative analysis of complications and costs. Ann Thorac Surg, 2012, 94 (6):1848-1853.
16. Gucu A, Toktas F, Eris C, et al. Nitinol thermoreactive clips for secondary sternal closure in cases of noninfective sternal dehiscence. Tex Heart Inst J, 2012, 39 (4):513-516.
17. Levin LS, Miller AS, Gajjar AH, et al. An innovative approach for sternal closure. Ann Thorac Surg, 2010, 89 (6):1995-1999.
18. 刘伟, 余国祥, 樊汉利, 等.胸大肌瓣移植在慢性胸骨骨髓炎治疗中的应用.中国胸心血管外科临床杂志, 2002, 9 (4):285.
19. 孙广龙, 曹向戎, 张健群.双侧胸大肌内侧头转移术治疗心脏术后胸骨哆开.中国胸心血管外科临床杂志, 2013, 20 (2):185-187.
20. Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg, 2002, 21 (5):825-830.
21. Tegnell A, Aren C, Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg, 2000, 69 (4):1104-1109.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Vascularized Muscle Flap Transposition Combined with Negative Pressure Wound Therapy for the Treatment of Complicated Mediastinitis after Cardiac Surgery in One-stage

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