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Plastic Surgery International
Volume 2013 (2013), Article ID 571685, 6 pages
http://dx.doi.org/10.1155/2013/571685
Clinical Study

Open Reduction Internal Fixation Poststernotomy Mediastinitis

Division of Plastic Surgery, Department of Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine Road, A500, Montreal, QC, Canada H3T 1E2

Received 11 March 2013; Revised 25 May 2013; Accepted 18 June 2013

Academic Editor: Nicolo Scuderi

Copyright © 2013 Hani Sinno and Tassos Dionisopoulos. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.