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The Journal of Cardiovascular Surgery 2000 October;41(5):715-9

language: English

Treatment of recurrent postoperative mediastinitis with granulated sugar

De Feo M., Gregorio R., Renzulli A., Ismeno G., Romano G. P., Cotrufo M.

From the Institute of Cardiac Surgery Second University of Naples V. Monaldi Hospital, Naples, Italy


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Background. The authors ­report ­their expe­ri­ence ­with gran­u­lat­ed sug­ar as dress­ing tech­nique in the treat­ment of ­postoper­a­tive med­i­as­tin­itis refrac­to­ry to a ­closed irri­ga­tion ­system.
Methods. Between January 1990 and January 1998, med­i­as­tin­itis devel­oped in 61 (0,93%) of 6521 ­patients who had under­gone ­open ­heart sur­gery. Diagnosis of ster­nal infec­tions was ­based on ­wound ten­der­ness, drain­age, cel­lu­litis, ­fever asso­ciat­ed ­with ster­nal instabil­ity. All of ­them ­were initial­ly treat­ed ­with sur­gi­cal debride­ment and ­closed ­chest irri­ga­tion. Nine ­patients ­with post­car­di­ot­o­my med­i­as­tin­itis refrac­to­ry to ­closed ­chest irri­ga­tion under­went ­open dress­ing ­with gran­u­lat­ed sug­ar. All of ­them ­were feb­rile ­with leu­ko­cy­to­sis and pos­i­tive ­wound cul­tures.
Results. Bacteria iso­lat­ed ­were staph­y­lo­coc­cus aure­us in 6 cas­es, staph­y­lo­coc­cus epi­der­mi­dis in 2 and pseu­do­mo­nas in 1. Redebridement was per­formed in all cas­es and the ­wound was ­filled ­with gran­u­lat­ed sug­ar ­four ­times a day. Fever ­ceased with­in 4.3±1.3 ­days ­from the begin­ning of treat­ment and WBC ­became nor­mal ­after 6.6±1.6 ­days. Three ­patients had hyper­bar­ic ther­a­py as asso­ciat­ed treat­ment. Complete ­wound heal­ing was ­achieved in 58.8±32.9 ­days (­three ­patients under­went suc­cess­ful pectoralis mus­cle ­flaps).
Conclusions. Sugar treat­ment is a rea­son­able and effec­tive ­option in ­patients ­with med­i­as­tin­itis refrac­to­ry to ­closed irri­ga­tion treat­ment. It may be ­used ­either as pri­mary treat­ment or as a ­bridge to pec­tor­al­is mus­cle ­flaps.

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