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      Epiplooplastie médiastinale dans le traitement d'une médiastinite post chirurgie cardiaque: à propos d'un cas Translated title: Mediastinal omental flap in the treatment of post cardiac surgery mediastinitis: report of a case

      case-report

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          Abstract

          Nous rapportons le cas d'un patient diabétique et obèse, opéré d'une chirurgie de revascularisation myocardique avec l'utilisation des deux artères mammaires internes comme greffon. L'intervention s'est compliquée d'une médiastinite traitée premièrement à thorax fermé et secondairement par une épiplooplastie. Cette technique reste efficace dans les médiastinites graves et délabrantes. Tout chirurgien cardiaque et digestif doit la connaitre.

          Most cited references6

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          Mediastinitis after more than 10,000 cardiac surgical procedures.

          Kaisa Huotari, Outi Lyytikäinen, Veli-Jukka Anttila … (2006)
          Poststernotomy mediastinitis as a complication is rare but disastrous. We assessed incidence, predisposing factors for, and outcome from, mediastinitis after cardiac surgery. We studied 10,713 consecutive patients who underwent open-heart surgery from 1990 to 1999 in a tertiary care university hospital using data prospectively recorded in the hospital discharge register, operating room log, and the hospital's cardiothoracic surgery unit register. Those cases with possible mediastinitis were identified from the hospital infection register and discharge register. Patients' charts were reviewed and cases of mediastinitis confirmed based on criteria of the Centers for Disease Control and Prevention. The overall rate of mediastinitis was 1.1% (120 cases), and higher in coronary artery bypass surgery than in valvular surgery (1.2 vs 0.8%). No trend in incidence was detectable, although surgical patients became progressively older (mean age, 59 to 65 years, p 30 kg/m2), rates of mediastinitis were 0.5%, 1.0%, and 1.8%. In multivariate analysis adjusted for age, sex, year, operation type, and perfusion time, the only predictor for mediastinitis was BMI. Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures.
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            Comparison of omental and pectoralis flaps for poststernotomy mediastinitis.

            Carmelo A. Milano, Gregory S Georgiade, Lawrence H Muhlbaier … (1999)
            Pectoralis flaps are frequently used to treat poststernotomy mediastinitis. We compared the outcomes of omental transfer, an alternative treatment for mediastinitis, with those of pectoralis flaps. Patients treated for poststernotomy mediastinitis with isolated omental flaps (n = 21) were compared with a group of consecutive patients treated with pectoralis flaps (n = 38). Baseline characteristics were equivalent for the two groups, and both early and late outcomes were compared. Length of procedure and length of postoperative hospitalization were reduced significantly and there were significantly fewer early complications in the group treated with omental flaps. Furthermore, there were no early or late flap failures or abscesses in the omental flap group. This study found that omental flaps had improved early outcomes and are a more effective therapy relative to pectoralis flaps for poststernotomy mediastinitis. Technical considerations for omental transfer that could optimize results are given.
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              Acute poststernotomy mediastinitis managed with debridement and closed-drainage aspiration: factors associated with death in the intensive care unit.

              Jean-Louis Trouillet, Albert Vuagnat, Alain Combes … (2005)
              The purpose of the study is to describe an intensive care unit's experience in the treatment of poststernotomy mediastinitis and to identify factors associated with intensive care unit death.
              Article 0 comments Cited 11 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pan Afr Med J
                Journal ID (iso-abbrev): Pan Afr Med J
                Journal ID (publisher-id): PAMJ
                Title: The Pan African Medical Journal
                Publisher: The African Field Epidemiology Network
                ISSN (Electronic): 1937-8688
                Publication date (Electronic): 21 November 2014
                Publication date Collection: 2014
                Volume: 19
                Electronic Location Identifier: 308
                Affiliations
                [1 ]Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
                Author notes
                [& ]Corresponding author: Hicham Labsaili, Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut du Cœur, Hôpital de la pitié salpêtrière, Paris, France
                Article
                Publisher ID: PAMJ-19-308
                DOI: 10.11604/pamj.2014.19.308.5596
                PMC ID: 4393996
                SO-VID: fbd03810-29ee-45fd-ac49-cf6a5afa28cf
                Copyright © © Hicham Labsaili et al.
                License:

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 October 2014
                Date accepted : 13 November 2014
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: médiastinite,épiplooplastie,infection du site opératoire,mediastinitis,omental flap,surgical site infection
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: médiastinite, épiplooplastie, infection du site opératoire, mediastinitis, omental flap, surgical site infection

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