Management of deep sternal wound infection after cardiac surgery--Hanuman syndrome.

Deep sternal wound infection following open-heart surgery caused sternal osteitis in eight patients and mediastinitis in 27 during 1980-1989. The incidence of such infection was 0.5%. Infection was more common during the last 2 years than in 1980-1987 (0.8% vs. 0.4%), and when bilateral internal mammary artery grafts were dissected (3.2% vs. 0.6% when only one internal mammary artery was used). Cure of mediastinitis was achieved by primary closed irrigation in four of 13 patients and by primary open treatment in five of ten. Muscle flap was employed in totally ten patients and omentum in four before final elimination of infection. Of the 27 patients with mediastinitis, eight (30%) died in the postoperative period of cardiac failure (3 cases), disseminated infection (2), bleeding (2) or aspiration (1). The 5-year survival rate was 43%. Prosthetic valve endocarditis caused one late death and necessitated one reoperation. If eradication of postoperative mediastinitis is not achieved by early diagnosis, debridement and closed irrigation, transposition of muscle or omentum should be considered.