Management of poststernotomy mediastinitis: Experience and results of different therapy modalities

Background: Different primary treatment modalities have been utilized to treat poststernotomy mediastinitis (PM) following cardiac surgery. Methods: A literature survey using the key phrases treatment of deep sternal wound infection and poststernotomy-mediastinitis was performed. Furthermore, a questionnaire regarding the primary treatment of PM was distributed to all 79 German heart surgery centers. Results: The review of the literature shows that the current understanding is based purely on retrospective studies, not on evidence-based medicine. All 79 German heart centers replied to the questionnaire. Vacuum-assisted closure therapy (V.A.C.(R)) is used in 28/79 (35%) heart centers as the first-line treatment, 22/79 (28%) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37%) German heart centers both treatment options were used according to the intraoperative conditions. Conclusions: As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V.A.C.(R) therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.