الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Median sternotomy is the conventional incision in open heart surgery. One of
its most serious complication is mediastinitis, when this complication occurs ,
there is significant morbidity and mortality rate which exceeds 20%.
There are different methods of classifying types of mediastinitis but they are
all about whether it is superficial infection affecting the skin and subcutaneous
tissue or deep wound infection affecting the sternum and mediastinum.
Many studies have been carried out to identify risk factors which can be
categorized as medical causes such as obesity, COPD, DM and operative causes
such as surgical technique, antiseptic preparations, antibiotic and the use of internal
mammary arteries .
Early diagnosis and proper treatment is the key point in this serious problem.
It depends mainly on high index of suspicion and daily examination. Although
there are some investigations which might help in the diagnosis, but they are far
less evident than clinical diagnosis.
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Summary
As the mediastinitis is a major complication many studies were done to find
methods of prophylaxis concerned mainly with aseptic conditions, antibiotic
prophylaxis, optimizing conditions of wound healing and the surgical technique
especially those concerned with rigid bone fixation.
Surgical treatment is mandatory in most cases with early aggressive
debridement in all cases, where some claims that open treatment and late closure
is successful, while most surgeons adopt the theory that primary muscle or omental
flap may achieve earlier and better results.
Recently, reconstruction using variable tissue flaps to obliterate dead space
and provide immediate coverage of the thoracic contents, showed very high
success rate. The omentum, pectoralis major, rectus abdominis and latissimus drsi
muscle have been the most commonly used tissue flaps.
Lastly, The vacuum assisted closure provides a variable and effective
adjunctive method to treat postoperative wound infection after cardiac surgery and
is a good option as a first line therapy followed by closure with wires or muscles
and omental flaps.
The post operative care is an important issue not to be neglected as these
patients are usually high risk patients and has been debelited from this
complications. It has an important role in preventing morbidities afterwards