• Andras Kollar and Davis C Drinkwater.
• Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• J Card Surg. 2003 May 1; 18 (3): 245-52.

ObjectiveThe purpose of this study was to assess the results and applicability of a modified chest closure technique employing bilateral pectoral myocutaneous advancement flaps after sternal re-approximation for postoperative mediastinitis in cyanotic infants.MethodsThe study population is of a single surgeon's pediatric cardiac experience (n = 253) over a 2-year period. With retrospective hospital chart review six cases with deep sternal wound complications were identified (five mediastinitis and one hypoxemic wound necrosis). Sternal wound reconstruction was done with the above technique in all cases. Follow up was completed by outpatient record review and with telephone interviews.ResultsAll six cases presented in this paper were neonates or infants with complex cyanotic cardiac malformations. Following chest wall reconstruction all had complete resolution of their mediastinitis with no mortality and no wound healing complications. Three of them have since undergone elective staged repair, with no evidence of residual wound infection. Two babies died during follow-up as a result of progressive respiratory compromise.ConclusionFor postcardiotomy mediastinitis in cyanotic infants we recommend limited debridement and anatomic sternal reconstruction supported by bilateral pectoral myocutaneous advancement flap closure.

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