Pericardial flap prevents sternal wound complications

W. C. Nugent, E. L. Maislen, G. T. O'Connor, C. A. Marrin and S. K. Plume
Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH 03756.

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.