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Abstract
In spite of protocols of hospital infection control, improved antibiotic therapy and a sepsis of perioperative care, the incidence of postoperative deep sternal wound infection has not decreased over the years. Incidence of postoperative mediastinal infections ranges between 0.15 to 8% and in averages 1-2% in the most recent reported series. Despite the low incidence of postoperative deep sternal wound infections and defects, they are significant cause of death and life threatening complications. As the postoperative sternotomy wound infection and defects are major complication and may be a main cause of death in such cases, it is better to avoid this complication as much as possible by following high sterile techniques, instruments and operative theaters. Early diagnosis and proper treatment is the key point in this serious problem. Early diagnosis depends on high index of suspicion and daily examination of the patient. Once diagnosis is established, early treatment is mandatory to prevent more complications and more tissue destruction. Early aggressive debridement is anyway mandatory. Some authors claim a higher success rate with open treatment, others support 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 dorsi muscles have been the most commonly used tissue flaps. The vaccum assisted closure provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after cardiac surgery.