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William C. Nugent, MD; Elizabeth L. Maislen, RN; Gerald T. O'Connor, PhD, DSc; Charles A. S. Marrin, MB, BS; Stephen K. Plume, MD

Arch Surg. 1988;123(5):636-639.

Abstract
• By interposing a pedicle of pericardium between the heart and sternum, mediastinitis may be prevented and sternal healing facilitated. Between Jan 1, 1984, and mid-1986, before we began using the pericardial flap, the overall incidence of mediastinitis and/or sternal wound dehiscence was 2.73% (26 of 952 patients). This rate did not differ significantly among three surgeons (2.53%, 2.95%, and 2.69%). During mid-1986, two of the three surgeons adopted the use of the pericardial flap and used it on 226 of 270 patients. None of these 270 patients developed mediastinitis or sternal wound dehiscence. The third surgeon did not adopt the use of the flap and operated on 100 patients during the same period. In this group, there were three cases of mediastinitis. This difference was statistically significant. No specific complications attributable to construction of a pericardial flap were identified in our patients. We conclude that the routine use of a pericardial flap is a safe, simple, and effective means of preventing mediastinitis and/or sternal dehiscence following cardiac surgery.

(Arch Surg 1988;123:636-639)

Author Affiliations
From the Section of Cardiothoracic Surgery, Department of Surgery (Drs Nugent, Marrin, and Plume, and Ms Maislen) and the Departments of Community Medicine and Family Medicine (Dr O'Connor), Dartmouth-Hitchcock Medical Center, Hanover, NH.

Footnotes
Accepted for publication Jan 27, 1988.

Read before the Annual Meeting of the New England Surgical Society, Bretton Woods, NH, Sept 13, 1987.

Reprint requests to the Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756 (Dr Nugent).

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