Iatrogenic bronchopleural fistula occuring during redo cardiac surgery.

Cardiac re-operations are associated with increased morbidity and mortality rates due to adhesion of tissues in the anterior mediastinum. Especially, previous usage of left internal thoracic artery constitutes a major challenge for cardiovascular surgeons. In such cases, the left lung frequently adheres to the thoracic wall and may be injured during dissection. This leads to air leak and the complication may in turn increase the risk of mediastinal infections and the hospital stay. A bronchopleural fistula case treated by a novel technique is reported. In patient iatrogenic bronchopleural fistula occured during dissection of the adhesions which resulted due to the first coronary artery bypass grafting and left internal thoracic artery usage. The air leakage was successfully controlled and treated by a novel method: self adhesive BioGlue immersed and coated Surgicel patch. Although it is a single case experience it may be a promising method as it is less traumatic when compared to the classical treatment methods of bronchopleural fistula.

Sternal cyanoacrylate gluing in mediastinitis. Effects on infection, stability and bone healing.

BACKGROUND: It is crucial to determine stability, histocompatibility and antibacterial properties of the cyanoacrylate used for sternal fixation. METHODS: Clinical study: in 17 cases of mediastinitis, debridement and rewiring the sternum, was applied as the treatment method (Group I). Eighteen cases of mediastinitis were treated with the same method added sternal cyanoacrylate gluing (Group II). A comparative study was done; the follow-up period was 36.7+/-4 and 18.5+/-6.9 months in Group I and II, respectively. Animal study: in 10 rats, upper sternotomy was done and the sternal bone was contaminated. Direct wound closure was done in 4 rats (Group A), in 6 animals, wounds were closed after applying cyanoacrylate in sternal split (Group B). In this prospective study, all rats alive were sacrificed at the 3rd and 8th weeks and sternums were examined histologically. RESULTS: Clinical study: in Group I, 6 patients required additional interventions due to recurrent sternal detachment and osteomyelitis (35.3%). In Group II neither osteomyelitis nor sternal detachment occurred, 3 patients required re-intervention related to cyanoacrylate histotoxicity. Hospital stay was higher in Group I than Group II (24.06+/-4.7 vs 14.16+/-3.98 days, respectively). Experimental study: all of the animals in Group A died of sepsis. In Group B all rats survived the procedure. At the 3rd week histologic evaluations showed that cyanoacrylate was not degraded, and no infection or foreign body reaction was observed. At the 8th week histologic examination showed that cyanoacrylate was completely degraded and replaced by connective tissue. CONCLUSIONS: Cyanoacrylate is effective in diminishing sternal wound complications and related cost and hospital stay of mediastinitis.

Cyanoacrylate gluing increases the effectiveness of systemic antimicrobial treatment in sternal infection: experimental study in a rodent model.

BACKGROUND: Sternal infection is a serious complication of cardiac surgery requiring resternotomy and radical debridement. In this experimental study, we aimed to test our hypothesis that the use of cyanoacrylate gluing (application of an acrylic resin, a monomer of cyanoacrylate molecules, which rapidly polymerizes in the presence of water, forming long, strong chains and joining the bonded surfaces together) together with systemic antimicrobial therapy will provide synergy for the treatment of sternal infection caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Forty Wistar albino rats were randomly divided into four groups: Group I, uncontaminated sham group; Group II, untreated contaminated control group; Group III, contaminated group receiving only systemic vancomycin therapy; Group IV, contaminated group treated with a combination of cyanoacrylate gluing and systemic vancomycin. Cyanoacrylate gluing was applied on the 3rd postoperative day and all rats alive at the end of 8th week were sacrificed. The degree of sternal infection was assessed histologically and also by quantitative culture analysis. RESULTS: Histological evaluation revealed that cyanoacrylate was degraded and replaced by connective tissue at the end of the 8th week. Culture analysis revealed that the average growth of microorganisms was significantly reduced in Groups III and IV. In Group IV, the reduction in the amount of growing microorganisms was found to be more pronounced and significantly lower than in Groups II and III. CONCLUSION: Our experimental model suggests that cyanoacrylate gluing provides significant synergy for systemic antimicrobial therapy. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of mediastinitis and sternal osteomyelitis in rats.