[A case of delayed mediastinitis after coronary bypass grafting]

We experienced a case of delayed mediastinitis, who had coronary bypass surgery using saphenous vein graft fifteen months before. At that time, a Gore-Tex pericardial sheet had been used for protection from adhesion. Persistent discharge from unhealed small fistula, which appeared at ten months after surgery, gave notice of mediastinitis. It was supposed that complicated diabetes mellitus might be causative of this infection. A bacterial examination detected serratia marcescence and a fistulography proved a cavity between the sternum and the Gore-Tex pericardial sheet. At first, we took out the infected sternum and the Gore-Tex pericardial sheet, and mediastinal lavage was carried out for three days with 0.5% povidone iodine solution 80 ml/hour. After the wound was aseptic, the left major pectral muscle flap with vascular pedicle was transferred into the anterior mediastinal space. For twenty-two months after repair, he has been free from recurrence.