Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm

European Journal of Cardio-thoracic Surgery

Volumn 30, Issue 6, 2006, Pages 898-905

  Sjögren, Johan ^a   Malmsjö, Malin ^a   Gustafsson, Ronny ^a   Ingemansson, Richard ^a  

^a LUND UNIVERSITY HOSPITAL   (Sweden)

Author keywords

Mediastinitis; Review; Thoracic surgery; Wound closure

Indexed keywords

IMIPENEM; VANCOMYCIN;

ALGORITHM; FUNGUS; GRAM NEGATIVE BACTERIUM; GRAM POSITIVE BACTERIUM; HUMAN; MEDIASTINITIS; MORBIDITY; MORTALITY; NEGATIVE PRESSURE VENTILATION; NONHUMAN; OMENTUM; OPEN HEART SURGERY; PATHOGENESIS; PECTORAL MUSCLE; POSTOPERATIVE INFECTION; PRIORITY JOURNAL; REVIEW; STAPHYLOCOCCUS AUREUS; STAPHYLOCOCCUS EPIDERMIDIS; STERNOTOMY; SURGICAL TECHNIQUE; SURVIVAL; TISSUE FLAP; UNIVERSITY HOSPITAL; VACUUM ASSISTED CLOSURE; WOUND HEALING;

ALGORITHMS; HUMANS; MEDIASTINITIS; RISK FACTORS; STERNUM; SURGICAL WOUND INFECTION; VACUUM; WOUND HEALING;

EID: 33750947309     PISSN: 10107940     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ejcts.2006.09.020     Document Type: Review

References (86)

1. Mangram A.J., Horan T.C., Pearson M.L., Silver L.C., and Jarvis W.R. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27 (1999) 97-132
2. Gardlund B., Bitkover C.Y., and Vaage J. Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg 21 (2002) 825-830
3. Tegnell A., Aren C., and Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg 69 (2000) 1104-1109
4. Baskett R.J., MacDougall C.E., and Ross D.B. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 67 (1999) 462-465
5. Grossi E.A., Culliford A.T., Krieger K.H., Kloth D., Press R., Baumann F.G., and Spencer F.C. A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures. Ann Thorac Surg 40 (1985) 214-223
6. Shafir R., Weiss J., Gur E., Herman O., Siegman-Igra Y., Sorkine P., and Rudick V. Sternal wound infection: our experience with 200 cases. J Cardiovasc Surg (Torino) 35 6 Suppl. 1 (1994) 103-104
7. Jakob H.G., Borneff-Lipp M., Bach A., von P.S., Windeler J., Sonntag H., and Hagl S. The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg 17 (2000) 154-160
8. Cimochowski G.E., Harostock M.D., Brown R., Bernardi M., Alonzo N., and Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 71 (2001) 1572-1578
9. Borger M.A., Rao V., Weisel R.D., Ivanov J., Cohen G., Scully H.E., and David T.E. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 65 (1998) 1050-1056
10. Milano C.A., Kesler K., Archibald N., Sexton D.J., and Jones R.H. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation 92 (1995) 2245-2251
11. Ottino G., De P.R., Pansini S., Rocca G., Tallone M.V., Comoglio C., Costa P., Orzan F., and Morea M. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 44 (1987) 173-179
12. Lu J.C., Grayson A.D., Jha P., Srinivasan A.K., and Fabri B.M. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 23 (2003) 943-949
13. Loop F.D., Lytle B.W., Cosgrove D.M., Mahfood S., McHenry M.C., Goormastic M., Stewart R.W., Golding L.A., and Taylor P.C.J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 49 (1990) 179-186
14. Crabtree T.D., Codd J.E., Fraser V.J., Bailey M.S., Olsen M.A., and Damiano Jr. R.J. Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg 16 (2004) 53-61
15. Furnary A.P., Zerr K.J., Grunkemeier G.L., and Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67 (1999) 352-360
16. Ridderstolpe L., Gill H., Granfeldt H., Ahlfeldt H., and Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20 (2001) 1168-1175
17. Eagle K.A., Guyton R.A., Davidoff R., Ewy G.A., Fonger J., Gardner T.J., Gott J.P., Herrmann H.C., Marlow R.A., Nugent W.C., O'Connor G.T., Orszulak T.A., Rieselbach R.E., Winters W.L., Yusuf S., Gibbons R.J., Alpert J.S., Eagle K.A., Garson Jr. A., Gregoratos G., Russell R.O., and Smith Jr. S.C. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology/American Heart Association. J Am Coll Cardiol 34 (1999) 1262-1347
18. The Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 1996;111:1200-7.
19. Stahle E., Tammelin A., Bergstrom R., Hambreus A., Nystrom S.O., and Hansson H.E. Sternal wound complications-incidence, microbiology and risk factors. Eur J Cardiothorac Surg 11 (1997) 1146-1153
20. Douville E.C., Asaph J.W., Dworkin R.J., Handy Jr. J.R., Canepa C.S., Grunkemeier G.L., and Wu Y. Sternal preservation: a better way to treat most sternal wound complications after cardiac surgery. Ann Thorac Surg 78 (2005) 1659-1664
21. Krabatsch T., and Hetzer R. Poststernotomy mediastinitis treated by transposition of the greater omentum. J Card Surg 10 (1995) 637-643
22. Braxton J.H., Marrin C.A., McGrath P.D., Morton J.R., Norotsky M., Charlesworth D.C., Lahey S.J., Clough R., Ross C.S., Olmstead E.M., and O'Connor G.T. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg 16 (2004) 70-76
23. Toumpoulis I.K., Anagnostopoulos C.E., Derose Jr. J.J., and Swistel D.G. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest 127 (2005) 464-471
24. Sarr M.G., Gott V.L., and Townsend T.R. Mediastinal infection after cardiac surgery. Ann Thorac Surg 38 (1984) 415-423
25. Cartier R., Diaz O.S., Carrier M., Leclerc Y., Castonguay Y., and Leung T.K. Right ventricular rupture. A complication of postoperative mediastinitis. J Thorac Cardiovasc Surg 106 (1993) 1036-1039
26. Piwnica A., Abdelmeguid I., Mesnildrey P., Laborde F., Menasche P., Romano M., and Guedon C. Rupture of the right ventricular free wall. An unusual complication of mediastinitis after cardiac surgery. Eur J Cardiothorac Surg 2 (1988) 172-175
27. Arbulu A., Gursel E., Camero L.G., Asfaw I., and Stephenson L.W. Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?. Eur J Cardiothorac Surg 10 (1996) 110-115
28. Shumacker Jr. H.B., and Mandelbaum I. Continuous antibiotic irrigation in the treatment of infection. Arch Surg 86 (1963) 384-387
29. Bryant L.R., Spencer F.C., and Trinkle J.K. Treatment of median sternotomy infection by mediastinal irrigation with an antibiotic solution. Ann Surg 169 (1969) 914-920
30. Catarino P.A., Chamberlain M.H., Wright N.C., Black E., Campbell K., Robson D., and Pillai R.G. High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis. Ann Thorac Surg 70 (2000) 1891-1895
31. Rand R.P., Cochran R.P., Aziz S., Hofer B.O., Allen M.D., Verrier E.D., and Kunzelman K.S. Prospective trial of catheter irrigation and muscle flaps for sternal wound infection. Ann Thorac Surg 65 (1998) 1046-1049
32. DeFeo M., De Santo L.S., Romano G., Renzulli A., Della C.A., Utili R., and Cotrufo M. Treatment of recurrent staphylococcal mediastinitis: still a controversial issue. Ann Thorac Surg 75 (2003) 538-542
33. Durandy Y., Batisse A., Bourel P., Dibie A., Lemoine G., and Lecompte Y. Mediastinal infection after cardiac operation. A simple closed technique. J Thorac Cardiovasc Surg 97 (1989) 282-285
34. Calvat S., Trouillet J.-L., Nataf P., Vuagnat A., Chastre J., and Gibert C. Closed drainage using Redon catheters for local treatment of poststernotomy mediastinitis. Ann Thorac Surg 61 (1996) 195-201
35. Kirsch M., Mekontso-Dessap A., Houël R., Giroud E., Hillion M.-L., and Loisance D.Y. Closed drainage using Redon catheters for poststernotomy mediastinitis: results and risk factors for adverse outcome. Ann Thorac Surg 71 (2001) 1580-1586
36. Jurkiewicz M.J., Bostwick III J., Hester T.R., Bishop J.B., and Craver J. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg 191 (1980) 738-744
37. Jones G., Jurkiewicz M.J., Bostwick J., Wood R., Bried J.T., Culbertson J., Howell R., Eaves F., Carlson G., and Nahai F. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 225 (1997) 766-776
38. Wettstein R., Erni D., Berdat P., Rothenfluh D., and Banic A. Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis. J Thorac Cardiovasc Surg 123 (2002) 1185-1190
39. Klesius A.A., Dzemali O., Simon A., Kleine P., bdel-Rahman U., Herzog C., Wimmer-Greinecker G., and Moritz A. Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg 25 (2004) 218-223
40. Lee Jr. A.B., Schimert G., Shaktin S., and Seigel J.H. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery 80 (1976) 433-436
41. Milano C.A., Georgiade G., Muhlbaier L.H., Smith P.K., and Wolfe W.G. Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann Thorac Surg 67 (1999) 377-380
42. Shibata T., Hattori K., Hirai H., Fujii H., Aoyama T., and Seuhiro S. Rectus abdominis myocutaneous flap after unsuccessful delayed sternal closure. Ann Thorac Surg 76 (2003) 956-958
43. Ringelman P.R., Vander Kolk C.A., Cameron D., Baumgartner W.A., and Manson P.N. Long-term results of flap reconstruction in median sternotomy wound infections. Plast Reconstr Surg 93 (1994) 1208-1214
44. Yuen J.C., Zhou A.T., Serafin D., and Georgiade G.S. Long-term sequelae following median sternotomy wound infection and flap reconstruction. Ann Plast Surg 35 (1995) 585-589
45. Argenta L.C., and Morykwas M.J. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38 (1997) 563-576
46. Fleischmann W., Strecker W., Bombelli M., and Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg 96 (1993) 488-492
47. Thomas G.P.L., and Banwell P.E. Topical negative-pressure therapy in wound management. In: Teot L., Banwell P.E., and Ziegler U.E. (Eds). Surgery in wounds (2004), Springer-Verlag, Heidelberg 109-124
48. Morykwas M.J., Argenta L.C., Shelton-Brown E.I., and McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38 (1997) 553-562
49. Wackenfors A., Sjögren J., Gustafsson R., Algotsson L., Ingemansson R., and Malmsjö M. Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood flow. Wound Repair Regen 12 (2004) 600-606
50. Wackenfors A., Gustafsson R., Sjögren J., Algotsson L., Ingemansson R., and Malmsjö M. Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy. Ann Thorac Surg 79 (2005) 1724-1730
51. Moues C.M., Vos M.C., van den Bemd G.J., Stijnen T., and Hovius S.E. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 12 (2004) 11-17
52. Weed T., Ratliff C., and Drake D.B. Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance?. Ann Plast Surg 52 (2004) 276-279
53. Banwell P.E. Topical negative pressure therapy in wound care. J Wound Care 8 (1999) 79-84
54. Morykwas M.J., David L.R., Schneider A.M., Whang C., Jennings D.A., Canty C., Parker D., White W.L., and Argenta L.C. Use of subatmospheric pressure to prevent progression of partial-thickness burns in a swine model. J Burn Care Rehabil 20 (1999) 15-21
55. Morykwas M.J. Sub-atmospheric pressure therapy: research evidence. In: Banwell P.E., and Teot L. (Eds). Topical negative pressure (TNP) therapy (2004), TXP Communications, Faringdon 39-44
56. Bennett DC, Komorowska-Timek E, Garbriel A, Gupta S. Characterizing the changing gene statement of chronic wounds treated with sub-atmospheric pressure therapy. Plastic Surgery Research Council 47th Annual Meeting, 2002, 4-17-0020.
57. Olenius M., Dalsgaard C.J., and Wickman M. Mitotic activity in expanded human skin. Plast Reconstr Surg 91 (1993) 213-216
58. Cherry G.W., Austad E., Pasyk K., McClatchey K., and Rohrich R.J. Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin. Plast Reconstr Surg 72 (1983) 680-687
59. Banwell P.E., and Teot L. Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 12 (2003) 22-28
60. Saxena V., Hwang C.W., Huang S., Eichbaum Q., Ingber D., and Orgill D.P. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114 (2004) 1086-1096
61. Chen K.D., Li Y.S., Kim M., Li S., Yuan S., Chien S., and Shyy J.Y. Mechanotransduction in response to shear stress. Roles of receptor tyrosine kinases, integrins, and Shc. J Biol Chem 274 (1999) 18393-18400
62. Domkowski P.W., Smith M.L., Gonyon Jr. D.L., Drye C., Wooten M.K., Levin L.S., and Wolfe W.G. Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thorac Cardiovasc Surg 126 (2003) 386-390
63. Luckraz H., Murphy F., Bryant S., Charman S.C., and Ritchie A.J. Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. J Thorac Cardiovasc Surg 125 (2003) 301-305
64. Fleck T.M., Fleck M., Moidl R., Czerny M., Koller R., Giovanoli P., Hiesmayer M.J., Zimpfer D., Wolner E., and Grabenwoger M. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg 74 (2002) 1596-1600
65. Doss M., Martens S., Wood J.P., Wolff J.D., Baier C., and Moritz A. Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiothorac Surg 22 (2002) 934-938
66. Song D.H., Wu L.C., Lohman R.F., Gottlieb L.J., and Franczyk M. Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure. Plast Reconstr Surg 111 (2003) 92-97
67. Tang A.T., Ohri S.K., and Haw M.P. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 17 (2000) 482-484
68. Obdeijn M.C., de Lange M.Y., Lichtendahl D.H., and de Boer W.J. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. Ann Thorac Surg 68 (1999) 2358-2360
69. Hersh R.E., Jack J.M., Dahman M.I., Morgan R.F., and Drake D.B. The vacuum-assisted closure device as a bridge to sternal wound closure. Ann Plast Surg 46 (2001) 250-254
70. Immer F.F., Durrer M., Muhlemann K.S., Erni D., Gahl B., and Carrel T.P. Deep sternal wound infection after cardiac surgery: modality of treatment and outcome. Ann Thorac Surg 80 (2005) 957-961
71. Agarwal J.P., Ogilvie M., Wu L.C., Lohman R.F., Gottlieb L.J., Franczyk M., and Song D.H. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg 116 (2005) 1035-1040
72. Cowan K.N., Teague L., Sue S.C., and Mahoney J.L. Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery. Ann Thorac Surg 80 (2005) 2205-2212
73. Routledge T., Saeb-Parsy K., Murphy F., and Ritchie A.J. The use of vacuum-assisted closure in the treatment of post-transplant wound infections: a case series. J Heart Lung Transplant 24 (2005) 1444
74. Yuh D.D., Albaugh M., Ullrich S., and Conte J.V. Treatment of ventricular assist device driveline infection with vacuum-assisted closure system. Ann Thorac Surg 80 (2005) 1493-1495
75. Sjögren J., Gustafsson R., Dobre M., Koul B., Ingemansson R., and Algotsson L. Vacuum-assisted closure therapy in mediastinitis after heart transplantation. J Heart Lung Transplant 23 (2004) 506-507
76. Gustafsson R.I., Sjögren J., and Ingemansson R. Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy. Ann Thorac Surg 76 (2003) 2048-2053
77. Sjögren J., Gustafsson R., Nilsson J., Malmsjö M., and Ingemansson R. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg 79 (2005) 2049-2055
78. Sjögren J., Nilsson J., Gustafsson R., Malmsjö M., and Ingemansson R. The impact of vacuum-assisted closure on long-term survival after post-sternotomy mediastinitis. Ann Thorac Surg 80 (2005) 1270-1275
79. Fleck T.M., Koller R., Giovanoli P., Moidl R., Czerny M., Fleck M., Wolner E., and Grabenwoger M. Primary or delayed closure for the treatment of poststernotomy wound infections?. Ann Plast Surg 52 (2004) 310-314
80. Fuchs U., Zittermann A., Stuettgen B., Groening A., Minami K., and Koerfer R. Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. Ann Thorac Surg 79 (2005) 526-531
81. Moidl R., Fleck T., Giovanoli P., Grabenwoger M., and Wolner E. Cost effectiveness of V.A. C. (R) therapy after poststernotomy mediastinitis. Zentralbl Chir 131 S 1 (2006) 189-190
82. Abboud C.S., Wey S.B., and Baltar V.T. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 77 (2004) 676-683
83. Bitkover C.Y., and Gardlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 65 (1998) 36-40
84. Demmy T.L., Park S.B., Liebler G.A., Burkholder J.A., Maher T.D., Benckart D.H., Magovern Jr. G.J., and Magovern Sr. G.J. Recent experience with major sternal wound complications. Ann Thorac Surg 49 (1990) 458-462
85. Nagachinta T., Stephens M., Reitz B., and Polk B.F. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 156 (1987) 967-973
86. Munoz P., Menasalvas A., Bernaldo de Quiros J.C., Desco M., Vallejo J.L., and Bouza E. Postsurgical mediastinitis: a case-control study. Clin Infect Dis 25 (1997) 1060-1064