[Plastic surgery procedures in the treatment of mediastinitis in adult]

Closed vacuum drainage is becoming the standard technique in most early postoperative mediastinitis, open wound treatment being only necessary in case of failure of the previous technique or in high grade mediastinitis. The reconstruction technique to be chosen depends on both resulting wound presentation after debridement and thorax morphology. Mediastinal dead space obliteration is a "sine qua non" for success often requiring multiple flap transposition. Since 1983, reconstructive procedures were carried out in 205 patients, of them 95 had bilateral pectoralis major turn-over transposition flaps on internal pedicules, following internal mammary artery coronary revascularisation in 45. Trapezius and latissimus dorsi were the next most used flaps. Transposition of the omentum although especially well suited for torpid wounds was to often precluded by bad abdominal risk factors. Conservative closed drainage salvaged by reconstructive procedures when necessary has greatly improved both survival and functional outcome of these patients.