[HSF] anaerobic late mediastinitis

[erdinç naseri]

dear all,
Thank you for your insightful comments. Unfortunately the patient developed 
full blown sepsis with hepatorenal insufficiency and died last night.Again 
thank you for precious advices.
erdinc


>From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: <OpenHeart-L at lists.hsforum.com>
>Subject: Re: [HSF] anaerobic late mediastinitis
>Date: Sat, 24 Mar 2007 11:54:42 +0900
>
>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?
>
>
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