[Successful surgical management for chronic sternal osteomyelitis and anterior mediastinal abscess after double valve replacement by total sternectomy and pectoralis major muscle flaps].

A 63-year-old woman underwent double (aortic and mitral) valve replacement in February, 1987. Thirty days later, purulent drainage developed at the sternotomy incision with high fever. Wound cultures revealed staphylococcus aureus. She was treated by local wound care with antibiotics. About one month later, she had a satisfactory wound healing. But three cutaneous fistulas with discharge emerged at the sternotomy incision in November (9 months later) and the cultures grew the same species. The fistulogram showed the communication between these tracts and the mediastinum. The diagnosis of chronic sternal osteomyelitis and anterior mediastinal abscess was made. At first the resection of the xiphoid process and the mediastinal drainage were carried out in March, 1988. Inspite of this procedure, she still had persistent purulent discharge. Then, en bloc excision of the infected sternum and the adjacent costal cartilage were performed in April. The defect was obliterated with the bilateral pectoralis major muscle flaps. After the radical operation, her wound was completely healed, even though the ventilatory support was needed for 24 days because of flail chest due to the anterior chest wall instability. Now she has been free from recurrence for four years. Total sternectomy and pectoralis major muscle plombage seem to be a very effective management in chronic sternal osteomyelitis.