Open Reduction Internal Fixation Poststernotomy Mediastinitis

Introduction. Mediastinitis has been reported to complicate 5% of sternotomy surgery. We have adopted an open reduction and rigid internal fixation (ORIF) approach during the conventional rescue surgery in the treatment of mediastinitis. Methods. A retrospective review was performed to compare the outcomes of patients that had an ORIF to correct postoperative mediastinitis following median sternotomy. These were compared with the outcome of the patients that did not undergo ORIF. Results. In the 5-year study period, we reviewed 35 mediastinitis patient charts. Postoperatively, the ORIF patient group remained in the Intensive Care Unit (ICU) and on a ventilator for a mean of 1.5 and 0.75 days, respectively. Patients treated without ORIF spent significantly more days in the ICU (mean of 7.5 days, ) and on a ventilator (mean of 2.15 days, ). Furthermore, it was found that none of the patients (0%) who underwent ORIF complained of any postoperative sternal instability or pain. Preoperatively, however, these rates were as high as 72%. Conclusions. In the select patient, ORIF can be a safe option in the management of mediastinitis, which we have shown to significantly decrease morbidity and mortality by providing anatomic reduction as well as physiologic stabilization. We have shown that ORIF will improve the quality of life of the patient by minimizing abnormal sternal mobility and pain and will also decrease inpatient costs by decreasing days spent in the ICU and ventilator dependence. 1. Introduction Since the introduction of the median sternotomy technique for cardiac surgery in the 1950’s and its support by surgeons such as Gerbode et al. [1] and Julian et al. [2], it has become the standard approach for open access to the anterior mediastinum. Although the wound complications of such operative techniques are relatively small (i.e., wound infections reach up to 2.1% and bony nonunion up to 5.1% of all cases), their consequences are extremely detrimental. Mortality rates have been reported up to 100% of all cases if untreated [3–9]. Wound infections have ranged from being benign involving the skin edges to more serious abscess formation involving skin, subcutaneous fat, bone, cartilage, and mediastinum structures. In addition, the separation of the bony sternum and manubrium after median sternotomy is referred to as sternal dehiscence. This phenomenon may be associated with infection, sternal wires shearing through the bone, wire rupture, sternal necrosis, sternal nonunion, mechanical stresses, and/or trauma. The transverse sternal fractures created by