Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient

Treatment of sternotomy dehiscence secondary to infection is complex. We describe a case where following debridement and negative pressure therapy the greater omentum was harvested laparoscopically, pedicled on the right gastroepiploic artery and transposed through a subxiphoid window and laid into the chest wound. The omentum was covered with a split skin graft. The omental transposition provided a healthy vascular bed for the skin graft to be laid on top of. This technique allows for larger defects to be closed when due to the amount of bone loss the sternum cannot be brought together. Such procedures are normally performed when all other measures have failed and myocutaneous flaps cover the omentoplasty. Our case is novel in that the laparoscopic harvest and the use of direct skin grafting make this an option to be considered earlier as a single definitive procedure.peer-reviewe

NECROTIZING FASCIITIS OF THE POSTERIOR CERVICAL COMPARTMENT: AN ATYPICAL CASE DUE TO STREPTOCOCCUS AGALACTIAE

Necrotizing fasciitis is a fulminant infection that affects the deep and superficial fascia while initially sparing the overlying skin and underlying muscle. The involvement of the cervicalcompartment is associated with a high morbidity and mortality rate. Immunocompromised patients are prone to this infection. We present a case of a 80 year-old diabetic womansuffering from streptococcal cervical NF (probably secondary to a arm injury) with an uncommon involvement of the posterior cervical compartment, highlighting the atypical responsible microorganism (Streptococcus Agalactiae), the role of imaging for early diagnosis and the timely surgical and medical treatment for a successful outcome.

The Characteristics of Postoperative Mediastinitis During the Changing Phases of Cardiac Surgery

Background. Mediastinitis is a serious complication of open heart surgery associated with high mortality, considerable health care costs, and prolonged hospital stay. We examined characteristics and incidence of mediastinitis during 29 years when indications and patient material have been in a process of change. Methods. This was a retrospective population-based study comprising all mediastinitis patients more than 16 years of age after open heart surgery between 1990 and 2018 from a population of 1.7 million. Patient records of 50 mediastinitis patients from 2004 to 2014 were reviewed and compared with 120 patients from 1990 to 1999. Results. Annual mediastinitis rate varied 0% to 1.5% with a decreasing trend-from a level exceeding 1.2% to approximately 0.3%-over the study period. In 2004 to 2014 patients with mediastinitis were older, more often smokers, and more often had diabetes mellitus and renal insufficiency than in 1990 to 1999. No difference in length of hospital treatment, antibiotic prophylaxis or treatment, intensive care unit treatment, or mortality was observed between 1990 to 1999 and 2004 to 2014. Coronary artery bypass graft surgery became less common and valve replacement and hybrid operations more common among operations leading to mediastinitis. Staphylococcus aureus increased (from 25% to 56%, p = .005) whereas coagulase-negative staphylococci (46% to 23%, P < .001) and gramnegative bacteria (18% to 12%, P = .033) decreased as causative agents. Surgery for mediastinitis remained similar except introduction of vacuum-assisted closure treatment. Conclusions. The rate of mediastinitis decreased during these 29 years. No difference in 30-day mortality in mediastinitis was seen: 0.9% in 1990 to 1999 and 2% in 2004 to 2014. (C) 2021 by The Society of Thoracic SurgeonsPeer reviewe

Sternal nonunion on bone scintigraphy: A case report

Sternal non-union is a severe complication of sternotomy closure following open heart surgeries. Healing problems typically occur in 0.3% to 5% of patients. Technetium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy has been used to assess bone nonunion to predict the healing response for proper management. In this report, we present the case of a marked sternal nonunion following coronary artery bypass graft (CABG), using radionuclide bone scintigraphy

Infectious Diseases Associated With Renal Homotransplantation: I. Incidence, Types, and Predisposing Factors

Infectious diseases occurred in 26 of 30 renal homotransplantation patients and contributed to eight of the 12 deaths in this series. There were 52 infections, 17 occurring before and 35 after transplantation. Infections were produced primarily by staphylococci, Pseudomonas species, and the enteric gram-negative bacilli. Staphylococcal infections occurred in 17 of 19 carriers of this organism and in only one of 11 noncarriers. Thirty-three of the 35 postoperative infections followed the intensification of immunosuppressive therapy for treatment of attempted homograft rejection. Granulocytopenia, steroid-induced diabetes, and hypogammaglobulinemia, from suppressive drug therapy, routinely preceded the onset of these complications. The infections, largely of endogenous origin, occurred when the host's defense mechanisms were depressed. © 1964, American Medical Association. All rights reserved

Investigation of mediastinitis due to coagulase-negative staphylococci after cardiothoracic surgery.

Six cases of coagulase-negative staphylococcal mediastinitis were identified in the latter half of 1999. A new preoperative cleansing solution was suspected by hospital staff to be a factor in the outbreak. We evaluated this possible risk factor along with other known and suspected surgical site infection risk factors in this case-control study

Management of deep space infections of the neck

Infections of the deep neck spaces often present a clinical challenge for the ENT surgeon. Management of these complex suppurations of the neck requires in fact a multidisciplinary approach due to possible complications like mediastinitis, septic shock and MSOF, life threatening bleeding and ICU management. The spread of infection from the primary site to other regions is possible through the lymphatic, arterial and venous vessels, or directly along the fasciae. There are several classifications for the etiology, pathogenic mechanism and site of evolution, the most frequently encountered clinical forms being peritonsillar abscess, retropharyngeal abscess, lateropharyngeal abscess, and the deep cervical abscess. All of these abscesses are suppurative complications of primary neck infections. Extensive inflammation and suppuration of the neck requires in most cases multiple incisions for drainage such that patients experience significant scarring of the neck. Along with the presence of the tracheostomy and nazo-gastric feeding tube, the aesthetic aspect of the neck surgery involves a high degree of psychological stress for the patients. As a conclusion and in line with literature data, patients must be fully informed about the technique and the outcome of the surgery so that they can provide informed consent since the pathology can be both life- threatening and mutilating

Staphylococcus aureus poststernotomy mediastinitis: Description of two distinct acquisition pathways with different potential preventive approaches

ObjectiveDetermining the acquisition routes of infection is crucial to designing specific preventive approaches against Staphylococcus aureus poststernotomy mediastinitis.MethodsFrom 2002 to 2004, a nasal sample was obtained from patients before cardiac surgery. We collected clinical and microbiologic data of all episodes of S aureus poststernotomy mediastinitis. A case–control study (3:1) was performed to confirm the role of previous preoperative nasal colonization by S aureus as a risk factor for S aureus poststernotomy mediastinitis. Pulsed field gel electrophoresis molecular analysis of nasal and surgical site S aureus isolates was performed to analyze their relatedness in each patient with poststernotomy mediastinitis and with other patients of the study cohort.ResultsS aureus nasal cultures were positive in 228 (15.9%) of 1432 patients: methicillin-susceptible S aureus in 222 (15.5%) and meticillin-resistant S aureus in 6 (0.4%). S aureus poststernotomy mediastinitis was diagnosed in 17 (1.2%) of 1432 patients: 9 (3.95%) of 228 in colonized patients versus 8 (0.66%) of 1204 in noncolonized patients (P < .0001). Seven of 9 patients (1.2%) with methicillin-susceptible S aureus had an identical isolate by pulsed field gel electrophoresis in preoperative nasal and surgical-site cultures, but no clonal relatedness was shown among the isolates from these 9 patients. None of the 8 patients with methicillin-resistant S aureus poststernotomy mediastinitis had an identical isolate by pulsed field gel electrophoresis in preoperative nasal and surgical-site cultures, and the same clone of methicillin-resistant S aureus was responsible for all these cases.ConclusionsNasal colonization often precedes methicillin-resistant S aureus poststernotomy mediastinitis, which suggests that decontamination is adequate for preventing methicillin-resistant S aureus poststernotomy mediastinitis, whereas hospital infection control measures seem to be the major factor for preventing methicillin-resistant S aureus poststernotomy mediastinitis

Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation