Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap
Yıl: 2023 Cilt: 26 Sayı: 2 Sayfa Aralığı: 88 - 95 Metin Dili: İngilizce DOI: 10.51645/khj.2023.m370 İndeks Tarihi: 20-07-2023
Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap
Öz: Introduction: Mediastinitis is a rare occurrence following cardiac surgeries; however, it is a significant cause of both mortality and morbidity. Given the significance of mediastinal infections, early diagnosis, and treatment become of paramount importance. The management of this condition necessitates a multidisciplinary approach, involving collaboration and coordination among various medical specialties. Patients and Methods: 21 patients with a diagnosis of deep mediastinal infection who were treated at Eskişehir Osmangazi University Medical Faculty Hospital between January 2015 and May 2021 were included in the study. Broad-spectrum antibiotic therapy, serial debridement, and vacuum-assisted closure were applied to all patients. Among the patients who exhibited negative blood cultures and developed granulation tissue, those with tissue losses that did not extend to the sternum incision sites were assessed for potential flap procedures in conjunction with plastic and reconstructive surgery. In such cases, closure of the wound was achieved using a pectoral muscle flap. All patients were followed for one year. Results: Among the patients, 14 (66.6%) were female and seven (33.3%) were male, with a mean age of 62.7 ± 6.5 (range: 41-76 years). Three of the 21 patients included in the study had type I, two had type II, and 16 had type IIIA mediastinitis. Staphylococcus aureus (S. aureus) was the most commonly isolated microorganism with 11 patients (52.3%). The right pectoralis major muscle was used in four patients (19%), the left pectoralis major muscle in four patients (19%), and the bilateral pectoralis major muscle in 13 patients (62%). There was no need for re-intervention in the follow-up of the patients. No mortality because of infection, surgical muscle flap closure, and/or cardiac causes was observed in any of the patients who were treated. Conclusion: Mediastinitis is a costly treatment, requiring prolonged hospitalization and carrying the risk of mortality. The main objective is to prevent the occurrence of mediastinitis. We believe that this objective should be pursued through a multidisciplinary approach involving cardiovascular surgery, infectious diseases, and plastic and reconstructive surgery units.
Anahtar Kelime: Kalp Cerrahisi Sonrası Görülen Derin Mediastinal Enfeksiyonların Pektoral Kas Flebi ile Tedavisi
Öz: Giriş: Mediastinit, kalp cerrahisi sonrası nadir görülmesine rağmen ciddi bir mortalite ve morbidite sebebidir. Bu nedenle derin mediastinal enfeksiyonların erken tanı ve tedavisi çok önemlidir. Bu durumun yönetimi ise multidisipliner yaklaşım gerektiren bir süreçtir. Hastalar ve Yöntem: Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesinde Ocak 2015-Mayıs 2021 tarihleri arasında görülen 21 derin mediastinal enfeksiyon tanılı hasta çalışmaya dahil edildi. Hastaların tamamına geniş spektrumlu antibiyoterapi, seri debridman ve vakum yardımlı kapama sistemi tedavileri uygulandı. Kültür sonucu negatifleşen ve yara yerinde granülasyon dokusu gelişen hastalardan sternum insizyon yerlerinde doku kaybı olan hastalara pektoral kas flebi ile yara yeri kapama yapıldı. Tüm hastalar bir yıl boyunca takip edildi. Bulgular: Hastaların 14’ü kadın (%66.6), yedisi erkek (%33.3) olup yaş ortalamaları 62.7 ± 6.5 (dağılım: 41-76 yaş) idi. Çalışmaya dahil olan 21 hastanın üçü tip I, ikisi tip II, 16’sı ise tip IIIA mediastinit olgularıydı. En çok izole edilen mikroorganizma 11 hastada görülen Staphylococcus aureustu (S. aureus). Dört hastada (%19) sağ pektoralis majör kası, dört hastada (%19) sol pektoralis majör kası, 13 hastada (%62) ise bilateral pektoralis majör kası flep olarak kullanıldı. Hastaların takiplerinde tekrar girişim ihtiyaçları olmadı. Tedaviye alınan hiçbir hastada enfeksiyon nedenli, cerrahi kas flebi ile kapamaya bağlı ve/veya kardiyak nedenlere bağlı mortalite gözlenmedi. Sonuç: Derin mediastinal enfeksiyonların tedavisi yüksek maliyetli, uzun süreli yatış gerektiren ve ölüm ile sonuçlanabilen bir durumdur. Öncelikli amaç kalp cerrahisi sonrasında mediastinit gelişmesine engel olmaktır. Mediastinit gelişen hastalarda kalp damar cerrahisi, enfeksiyon hastalıkları ve plastik ve rekonstrüktif cerrahi hekimlerinin multidisipliner yaklaşımı ile tedavi sürecini yönetmenin daha olumlu sonuçlar sağlayacağını düşünmekteyiz.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | Ovalı C, Kocaoglu A, Güçlüer Kocaoğlu M, Kocman A (2023). Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. , 88 - 95. 10.51645/khj.2023.m370 |
| Chicago | Ovalı Cengiz,Kocaoglu Alper Selim,Güçlüer Kocaoğlu Merve Nur,Kocman Atacan Emre Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. (2023): 88 - 95. 10.51645/khj.2023.m370 |
| MLA | Ovalı Cengiz,Kocaoglu Alper Selim,Güçlüer Kocaoğlu Merve Nur,Kocman Atacan Emre Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. , 2023, ss.88 - 95. 10.51645/khj.2023.m370 |
| AMA | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. . 2023; 88 - 95. 10.51645/khj.2023.m370 |
| Vancouver | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. . 2023; 88 - 95. 10.51645/khj.2023.m370 |
| IEEE | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A "Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap." , ss.88 - 95, 2023. 10.51645/khj.2023.m370 |
| ISNAD | Ovalı, Cengiz vd. "Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap". (2023), 88-95. https://doi.org/10.51645/khj.2023.m370 |
| APA | Ovalı C, Kocaoglu A, Güçlüer Kocaoğlu M, Kocman A (2023). Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal, 26(2), 88 - 95. 10.51645/khj.2023.m370 |
| Chicago | Ovalı Cengiz,Kocaoglu Alper Selim,Güçlüer Kocaoğlu Merve Nur,Kocman Atacan Emre Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal 26, no.2 (2023): 88 - 95. 10.51645/khj.2023.m370 |
| MLA | Ovalı Cengiz,Kocaoglu Alper Selim,Güçlüer Kocaoğlu Merve Nur,Kocman Atacan Emre Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal, vol.26, no.2, 2023, ss.88 - 95. 10.51645/khj.2023.m370 |
| AMA | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal. 2023; 26(2): 88 - 95. 10.51645/khj.2023.m370 |
| Vancouver | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap. Koşuyolu Heart Journal. 2023; 26(2): 88 - 95. 10.51645/khj.2023.m370 |
| IEEE | Ovalı C,Kocaoglu A,Güçlüer Kocaoğlu M,Kocman A "Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap." Koşuyolu Heart Journal, 26, ss.88 - 95, 2023. 10.51645/khj.2023.m370 |
| ISNAD | Ovalı, Cengiz vd. "Treatment of Deep Mediastinal Infections Following Cardiac Surgery with Pectoral Muscle Flap". Koşuyolu Heart Journal 26/2 (2023), 88-95. https://doi.org/10.51645/khj.2023.m370 |
