Deep-seated infective mediastinitis in post-coronary artery bypass grafting patients

The median sternotomy is the preferred incision for coronary artery bypass grafting (CABG) but its usage was initially associated with wound infection rates of up to 5%. The advent of antibiotic prophylaxis and improved surgical technique has improved these rates to 1% to 2% in most series. During a 5-year period from January 1988 to December 1992, 2193 patients underwent CABG in the Singapore General Hospital. Of these, 22 (1%) suffered postoperative wound infection. Thirteen (0.59%) of these had deep-seated mediastinitis which involved the osteocartilagenous tissues and retrosternal space and 9 (0.41%) had superficial wound infections. The superficial infections were successfully treated with dressings and delayed closure in all cases. The deep-seated infections, however, required in addition, antibiotic therapy, povidone iodine irrigation, repeated debridement and flap closure. In total, 6 muscle and myocutaneous flaps were used with good result. This paper reviews the Plastic Surgery unit's experience in treating this difficult postoperative complication.