[HSF] anaerobic late mediastinitis

[Tohru Asai]

Ajit

I had a case of 74yo obese COPD woman on steroid, status post total arch
replacement with 4-branched GelWeave graft last November. She developed deep
sternal wound infection caused by Staph at POD6.I reopened sternum, debrided
some tissue, watching graft starting from ST junction. I put omentum,
tailored to cover branched aortic graft mostly, together with irrigation
cath. She recouprated and discharged hospital 6 week after this. Last week,
I saw her doing well with no fever, no signs of infection. I was glad!

IMHO,microorganisms might not deeply invade between the fibers of graft
and/or anastomosis in my case and maybe erdinc's case. Or misterious omental
power may overcome these critical situation sometimes.   And probably, the
earlier the decision to perform the procedure,the better outcome we may
expect.

I have applied vacuum to many different postop infection and it has changed
our SSI dramatically! But one developed as deep mediastinitis from the
beginning, I would still perform sternal reexploration ( closed irrigation
and/or omental flap ).
-- 
Tohru Asai, M.D.
Director and Professor of Cardiovascular Surgery
Shiga University of Medical Science
Otsu, Japan

TEL +81-77-548-2241
FAX +81-77-544-2901
e-mail:toruasai at belle.shiga-med.ac.jp
URL:http://www.shiga-med.ac.jp/~toruasai/cv02.html



> Does anyone know if infection in a vascular graft in such a situation can be
> controlled without replacing it?