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Pericardial flap prevents sternal wound complications
W C Nugent1, E L Maislen, G T O'Connor
1Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH 03756.
Abstract:
By interposing a pedicle of pericardium between the heart and sternum, mediastinitis may be prevented and sternal healing facilitated. Between Jan 1, 1984, and mid-1986, before we began using the pericardial flap, the overall incidence of mediastinitis and/or sternal wound dehiscence was 2.73% (26 of 952 patients). This rate did not differ significantly among three surgeons (2.53%, 2.95%, and 2.69%). During mid-1986, two of the three surgeons adopted the use of the pericardial flap and used it on 226 of 270 patients. None of these 270 patients developed mediastinitis or sternal wound dehiscence. The third surgeon did not adopt the use of the flap and operated on 100 patients during the same period. In this group, there were three cases of mediastinitis. This difference was statistically significant. No specific complications attributable to construction of a pericardial flap were identified in our patients. We conclude that the routine use of a pericardial flap is a safe, simple, and effective means of preventing mediastinitis and/or sternal dehiscence following cardiac surgery.
Insights
Using a pericardial flap between the heart and sternum effectively prevents mediastinitis and sternal wound dehiscence after cardiac surgery. This simple technique enhances sternal healing and patient safety.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Innovation
Background:
- Mediastinitis and sternal wound dehiscence are significant complications following cardiac surgery.
- Previous surgical techniques had an overall incidence of 2.73% for these complications.
Purpose of the Study:
- To evaluate the efficacy of interposing a pericardial flap to prevent mediastinitis and sternal dehiscence.
- To assess the safety and impact of this surgical technique on sternal healing.
Main Methods:
- A retrospective analysis comparing outcomes before and after the adoption of a pericardial flap technique.
- Data collected from January 1984 to mid-1986 (pre-flap) and during mid-1986 (post-flap).
- Comparison of complication rates between surgeons using and not using the pericardial flap.
Main Results:
- Before flap use, mediastinitis/dehiscence incidence was 2.73% (26/952 patients).
- After adopting the pericardial flap, 0 out of 270 patients developed mediastinitis or sternal dehiscence.
- A statistically significant reduction in mediastinitis was observed in patients receiving the pericardial flap compared to those who did not.
Conclusions:
- The routine use of a pericardial flap is a safe and effective method for preventing mediastinitis and sternal dehiscence.
- This technique facilitates sternal healing and improves patient outcomes after cardiac surgery.
- No complications were attributed to the pericardial flap construction.