Treatment of sternal infections due to cardiac surgery – an interdisciplinary approach

Ennker, IC.; Ennker, J.

GMS Interdiscip Plast Reconstr Surg DGPW 2012;1:Doc18

A mediastinitis is a rare complication (incidence 1–4%) following cardiac surgery with a mortality of up to 50%. Treatment is somewhat difficult since no standardized treatment options are established. Thus, every German clinic proceeds differently.

It is thus the paper’s intention to describe an optimal treatment plan that guarantees higher patient safety, as well as determining whether the occurrence of postoperative infections can be diminished by raising awareness of involved risk factors.

Backed up by first-hand experiences in the treatment of mediastinitis patients a therapy algorithm correlating to the amount of infection was developed. The treatment consists of radical surgical debridement, sternal restabilization (depending on the elapsed time between procedure and cardiac operation) and vacuum therapy (as short as possible). Plastic reconstruction (usually via M. pectoralis plasty) may be performed as soon as supporting condition is attained. If treatment fails, the reconstruction of defects of the anterior chest wall is achievable by different muscle flaps.

Based on the results of early interdisciplinary cooperation, a therapy concept was developed, which is adaptable to the patient’s individual condition in order to ensure the best possible treatment concept concerning the patient’s recovery and safety.