Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage

Mediastinitis is an infrequent but life-threatening complication after cardiac operations. We reviewed our experience in treating eight select patients in whom this complication developed. Diffuse mediastinitis was verified at operation, and all patients were treated with the same surgical procedure by the same surgeon. The technique consisted of sternal bone débridement, mediastinal fat and connective tissue excision, pericardiectomy, and transfer of the greater omentum into the mediastinum on a vascular pedicle for obliteration of dead space. The sternum and sternal fascia were closed completely and the skin was closed loosely in each case. Postoperative drainage was not provided and postoperative irrigation was not performed. The mortality rate was 12.5% and the hospital stay averaged 27 days, comparable to other series in which irrigation has been used. We conclude from this review that the approach of omental transfer provides an alternative to prolonged irrigation and drainage of the mediastinum in the surgical management of these critically ill patients. This is neither a radical nor a disfiguring procedure, but is simple and easily done by the cardiac surgeon. Early ambulation, because of a lack of cumbersome irrigation and drainage apparatus, results in improved pulmonary function. Dead space is obliterated with tissue that has demonstrable ability to resist infection. Also, loose closure of the skin allows for primary healing with a good cosmetic result.