Simplified Negative Pressure Wound Therapy for Pediatric Mediastinitis after Cardiac Surgery

Hideki Ozawa	Shintaro Nemoto	Ryo Shimada
Shinji Fukuhara	Hayato Konishi	Yoshikazu Motohashi
Hiroaki Uchida and Takahiro Katsumata

（Department of Pediatric Cardiovascular Surgery＊, and Department of Cardiovascular Surgery＊＊, Osaka Medical University Hospital, Takatsuki, Japan）

Objectives:Mediastinitis results in significant morbidity in pediatric patients after cardiac surgery. The management of mediastinitis is not well established in the pediatric population. Our strategy for pediatric mediastinitis after cardiac surgery consists of rapid introduction of simple vacuum-assisted drainage system and sternal closure without plombage under aseptic conditions. The efficacy of our strategy was examined. Methods:The records of 7 pediatric patients with mediastinitis after cardiac surgery managed with this drainage system from May 2006 to May 2013 were retrospectively reviewed. The median age of the patients was 20.5 months and median body weight was 9.7kg. Mediastinitis occurred 1-3 weeks after surgery. The mediastinum was re-explored immediately under general anesthesia after the diagnosis was made, and continuous drainage was used after extensive debridement was performed. We developed a simple vacuum-assisted drainage system consisting of conventional polyurethane foam, surgical drape containing povidone-iodine, and 1 to 3 silicone drainage tubes connected to a drain aspirator（－99cmH2O). Patients were allowed oral intake and resumption of daily activity after extubation. The components of the drainage system were exchanged every 2-3 days. The sternum was closed without the use of the omentum or muscle for plombage of the mediastinum after two negative topical swab cultures were obtained. Results:Negative topical swab cultures were obtained in all cases（3-12 days after the drainage commencement）and the sternum was closed 7-19 days after the drainage commencement. The median duration of hospital stay was 31 days（range, 14-47). Although one patient with prenatal infection died of aortic rupture, the remaining six children survived and did not experience recurrence after hospital discharge. Conclusion:The simple vacuum-assisted drainage system enabled rapid control of wound bacterial infection and sternal closure in postoperative pediatric mediastinitis without the need for special, and expensive devices.

 

Jpn. J. Cardiovasc. Surg. 44:65-69（2015）

Keywords：pediatric cardiac surgery;mediastinitis;negative pressure wound therapy