{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:26:23Z","timestamp":1749947183675,"version":"3.37.3"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u2002<\/jats:title><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>We retrospectively analysed outcomes of debridement and primary sternal closure for postoperative mediastinitis in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Between January 2007 and July 2019, 1285 patients under the age of 20\u2009years underwent congenital heart surgery at the Iwate Medical University. Of these, 22 children had postoperative mediastinitis (1.7%). We performed adequate debridement and primary sternal closure with pectoralis major muscle advancement flaps. We evaluated hospital survival rates, reintervention, duration of intravenous antibiotic treatment, intensive care unit (ICU) stay and hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The median age and weight at surgery were 12.5\u2009months (range 0\u2013228\u2009months) and 7.8\u2009kg (range 2.2\u201364.2\u2009kg), respectively. Two patients (9%) had a history of delayed sternal closure. Staphylococcus was the most common causative agent for infection (82%). All cases were categorized as Robicsek\u2019s classification type II mediastinitis. The hospital survival rate was 95%, and freedom from reintervention for infectious complications was observed in 91% of the patients. The median durations of intravenous antibiotic treatment, ICU stay and hospital stay were 18\u2009days (range 9\u201346\u2009days), 4\u2009days (range 1\u201387\u2009days) and 22.5\u2009days (range 11\u201387\u2009days). The median follow-up time was 89\u2009months (range 2\u2013148\u2009months), and there was no evidence of recurrent mediastinitis, musculoskeletal growth, physical deformity, breast development and upper trunk or limb movement.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Primary sternal closure is an effective procedure for children as it can significantly shorten treatment duration and reduce physical and psychological burdens. Its results compare favourably with those of conventional therapy in terms of mortality and complications.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa477","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T20:20:40Z","timestamp":1607977240000},"page":"951-957","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of primary sternal closure for postoperative mediastinitis in children"],"prefix":"10.1093","volume":"59","author":[{"given":"Shigeto","family":"Tsuji","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5737-7293","authenticated-orcid":false,"given":"Akio","family":"Ikai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children\u2019s Hospital, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4090-025X","authenticated-orcid":false,"given":"Kotaro","family":"Oyama","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Iwate Medical University, Morioka, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2701-8257","authenticated-orcid":false,"given":"Hajime","family":"Kin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3940-8957","authenticated-orcid":false,"given":"Junichi","family":"Koizumi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Iwate, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"key":"2021050918070474800_ezaa477-B1","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.jtcvs.2004.04.023","article-title":"Primary closure for postoperative mediastinitis in children","volume":"128","author":"Ohye","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050918070474800_ezaa477-B2","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.athoracsur.2007.03.064","article-title":"Postoperative mediastinitis in children: improvement of simple primary closed drainage","volume":"84","author":"Anslot","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0022-5223(19)39957-X","article-title":"The prevention and treatment of sternum separation following open heart surgery","volume":"73","author":"Robicsek","year":"1977","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050918070474800_ezaa477-B4","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1177\/000313480006600215","article-title":"Postoperative sterno-mediastinitis","volume":"66","author":"Robicsek","year":"2000","journal-title":"Am Surg"},{"key":"2021050918070474800_ezaa477-B5","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0003-4975(99)01075-9","article-title":"Pectoralis major muscle flap for deep sternal wound infection in neonates","volume":"69","author":"Erez","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B6","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.athoracsur.2003.06.020","article-title":"Management of deep sternal infection in infants and children with advanced pectoralis major muscle flaps","volume":"77","author":"Sung","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B7","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/0003-4975(94)90179-1","article-title":"Vascularized muscle flaps for life threatening mediastinal wounds in children","volume":"57","author":"Backer","year":"1994","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B8","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1097\/00006534-198812000-00010","article-title":"Reconstruction of infant thoracic wounds","volume":"82","author":"Stahl","year":"1988","journal-title":"Plast Reconstr Surg"},{"key":"2021050918070474800_ezaa477-B9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0003-4975(10)65850-X","article-title":"Management of postoperative mediastinitis in infants and children by muscle flap rotation","volume":"46","author":"Stiegel","year":"1988","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B10","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S1010-7940(02)00562-6","article-title":"Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis","volume":"22","author":"Ramnarine","year":"2002","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021050918070474800_ezaa477-B11","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1510\/icvts.2005.122424","article-title":"Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants","volume":"5","author":"Fleck","year":"2006","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021050918070474800_ezaa477-B12","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.athoracsur.2007.09.004","article-title":"Vacuum-assisted closure for pediatric post-sternotomy mediastinitis: are low negative pressures sufficient?","volume":"85","author":"Kadohama","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B13","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/S0003-4975(03)00180-2","article-title":"Right ventricular rupture during use of high-pressure suction drainage in the management of poststernotomy mediastinitis","volume":"76","author":"Abu-Omar","year":"2003","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B14","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/j.athoracsur.2006.01.060","article-title":"Cardiac rupture during vacuum-assisted closure therapy","volume":"82","author":"Sartipy","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2021050918070474800_ezaa477-B15","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.ejcts.2006.09.020","article-title":"Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm","volume":"30","author":"Sj\u00f6gren","year":"2006","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/5\/951\/37900550\/ezaa477.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/5\/951\/37900550\/ezaa477.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,4]],"date-time":"2022-12-04T22:42:56Z","timestamp":1670193776000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/5\/951\/6133884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,12]]},"references-count":15,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,2,12]]},"published-print":{"date-parts":[[2021,5,8]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa477","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2021,2,12]]}}}