Mediastinal cutaneous fistulae arising as a complication of major cardiac surgery: the value of sinography and injection of methylene blue in their radical excision and immediate repair.

ABSTRACT

The management of chronic sternal wound infections is a difficult problem. Fistulography can be extremely useful in defining the extent of the infection. Staining the fistula with methylene blue aids the surgeon in the operative dissection and removal of infected material. A technique of reconstruction is described using an omental flap to fill in the retrosternal space and partially de-epithelialised pectoralis major myocutaneous flaps to cover the sternum.