Candidal Mediastinitis Successfully Treated Using Omentum Flap and Split‐Thickness Meshed Skin Flap Following Open‐Heart Surgery: A Case Report
Abstract
The prognosis of postoperative mediastinitis in critically ill patients, particularly those undergoing dialysis, remains poor. This report describes the case of an 84‐year‐old man with a history of diabetes diagnosed at 60 years of age and chronic kidney disease requiring dialysis since the age of 82 years. He presented with intermittent claudication and chest pain approximately 5 min after walking. Angiography revealed severe multivessel coronary artery disease. Consequently, off‐pump coronary artery bypass (OPCAB) grafting was carefully performed. Postoperative hemodynamics were stable, and he was discharged from the intensive care unit (ICU) the following day. However, on postoperative day 20, computed tomography (CT) revealed sternal nonunion and fluid accumulation in the anterior mediastinum and pericardial cavity. On postoperative day 42, further CT imaging showed sternal destruction, and culture testing identified
Candida albicans
, which showed no antifungal drug resistance. Fluconazole 100 mg was administered intravenously every other day following dialysis. After 3 weeks of treatment, fungal cultures from the wound site tested negative. However, the sternum and surrounding tissues remained fragile. A pectoralis major muscle flap was considered; however, the patient’s advanced age and reliance on dialysis resulted in insufficient muscle mass for adequate coverage. A three‐dimensional (3D) CT scan clearly identified the right omental artery, confirming sufficient…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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