Resternal closure versus pectoral muscle flap following omental flap in treatment of deep sternal wound infection

Background: Mediastinitis after cardiac surgery is defined as the infection of organs and spaces of the mediastinum, which may occur in 0.4%–2.4% of cases. When this complication occurs, it increases the length of hospital stay and hospital costs, besides being possibly lethal. Mortality can vary between 10% and 47%. Risk factors for mediastinitis includes: Uncontrolled diabetes, Obesity, Mammary harvesting, Prolonged ventilation, COPD, Massive blood transfusion and Osteoporosis. Methods: This study is a prospective study. It included 40 CABG patients between January 2012 to June 2014 in Cardiothoracic Surgery department, Faculty of Medicine, Cairo University. All patients underwent surgical debridement of necrotic and infected tissues and the removal of sternal wires followed by omental flap under general anesthesia. The patients were divided into two study groups: The first group (Resternal closure group) included 20 patients for whom the sternum was closed by wires. The second group (Pectoral muscle flap group) included 20 patients for whom the sternum was not closed and bilateral pectoral muscle flaps were done. Results: Patients in both groups were evaluated for postoperative extubation from mechanical ventilation, and mediastinitis for one month after surgery. In the first group (Resternal closure) 10 patients (50%) were extubated immediately postoperatively and 2 patients had deep sternal wound infection (DSWI) (10%) and died because of septicemia. In the second group (pectoral muscle flap), 8 patients (40%) were extubated immediately postoperatively and 1 patients (5%) has DSWI and died because of septicemia. Regarding early extubation immediately postoperatively and reinfection with DSWI with septic shock and mortality, there was no statically significant difference between both groups. Conclusion: Omental flap is safe, easy and effective technique in management of mediastinitis with DSWI following open heart surgery in CABG patients either this procedure was followed by reclosure of the sternum or bilateral pectoral flap. However, reclosure of the sternum is more physiological and less invasive than doing bilateral pectoral flap leaving the sternum unclosed