[HSF] anaerobic late mediastinitis

[Ben Bidstrup]

I agree. Esp in this case. Sounds like he will 
need some help from above as well. Debride what 
you think is necrotic tissue and leave open with 
vacuum.

>I have been successful in managing serious 
>mediastinal infections, both superficial and 
>deep, by the use of the vacuum. In this 
>particular case, once there is a couple of 
>dressing changes, I would apply vaccum, change 
>it every second day, and then reassess as to how 
>clean the wound is. >From your description, 
>however, muscle flaps will be needed once wound 
>is cleaner. In few selected patients, primary 
>closure is possible after weeks of vacuum.
>
>Tomas
>
>-----Original Message-----
>From: openheart-l-bounces at lists.hsforum.com 
>[mailto:openheart-l-bounces at lists.hsforum.com] 
>On Behalf Of erdinç naseri
>Sent: Friday, March 23, 2007 11:46 AM
>To: OpenHeart-L at lists.hsforum.com
>Subject: [HSF] anaerobic late mediastinitis
>
>
>Dear forum members,
>Opinion requested in the following case:
>76 y/o male applied for CABG and ascending aortic aneurysm(6.5 cmm at STJ
>),No AI.Supracoronary  ascending aortic replacement with tubular graft and
>CABG X 1 one month ago.Had abdominal distention at postop 5.th day. No
>fever.Diagnosed as paralytic ileus. stoped oral intake and followed by
>general surgery guys for one week conservatively.WBC 4000 considered normal
>by them but I told them that this is relative neutropenia in open heart
>surgery ( ususally 12-20000 in postop period).After one week started oral
>feeding and discharged.Applied 2 days ago with anemia, weakness and
>abdominal distention.Hospitalized by my colleagues and followed medicaly(
>Genaral surgeons agreed on medical follow up),I saw the patient yesterday.No
>fever with Partial dehiscence and wound was dirty( oozing bad smelly
>fluid).Immediately taken to ICU and monitorized.Started inotropics for low
>cardiac out put and took the patient to the operation room.Opened the
>sternum .Very fetid odor and semiclear fluid.Grafts intact ,coronary graft
>open.Deep bradycardia and hypotension and arrest followed by mannual
>massage.Cardiac activity returned but with maximum inotropic agents.Opened
>both pleura and put a tube in each and one in suprasternal notch for
>irrigation.He is in ICU  with unremitting fever (39-40)and Culture revealed
>E.coli.
>erdinc
>
>
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon