General Description

Surgery for the reconstruction of chest walls is performed mainly on two groups of patients: those suffering from an infection after a cardiothoracic procedure, and those suffering from congenital defects in the chest cavity (such as a concave or convex chest). The Unit performs surgery and follow-up treatment on all patients.

Treating Infections of the Chest Cavity Wall

Approximately 3% of patients who undergo cardiac surgery suffer complications and infections at various levels of severity at the surgical site.

The Department has been a pioneer in this field since 1984. The Ministry of Health recognized the need established the Unit for Chest wall Reconstruction, which is the only one of its kind in Israel. More than 600 patients from Israel and abroad have been treated in the Department.

Treating Infections of the Chest Cavity Wall

Approximately 1% of patients who undergo cardiac surgery suffer complications and infections at various levels of severity at the surgical site. Symptoms of infection include local redness and fever, puffiness, sensitivity, discharge from the open wound, general fever and weakness. These symptoms may appear within a week after surgery, or even several weeks or months later.

The cause of infection in these patients is not clear - it seems that the main causes are slow blood supply to the site due to the use of the internal mammary artery instead of the heart bypass arteries, mechanical friction on the tissues after their closure with surgical clips, which are a foreign body and, of course, the existence of bacteria around the open wound.

Infections of the surgical wound are divided into several levels of severity. The milder forms involve the superficial layers of tissue - skin and percutaneous fat. More severe cases affect the area of the metal flaps around the seam of the thoracic bone. The worst cases cause acute inflammation of the bone itself (osteomyelitis).

The main problem in dealing with these inflammatory conditions is that antibiotic treatment alone is not sufficient to eradicate the infection and there is a need to remove the infected bone and foreign objects and enable a good blood flow that will promote effective antibiotic healing.

Due to the complexity of cases doctors must carefully evaluate the medical condition, the involvement of the bone and the general state of the patient before deciding on the course of treatment. Main symptoms include the clinical condition of the patient, the appearance of the wound, blood tests and imaging tests, such as a chest x-ray and CT (computerized tomography). In relatively mild cases of infection of the sternum, a more conservative treatment will include cleaning the wound with antibacterial solutions, intravenous antibiotics, the removal of surgical flaps from the infected area and closing the wound. The closing of the wound is done in several ways, including vacuum for a few days, direct stitches on the open wound, or the placement of a skin graft on the site.

When the bone itself has become infected, a more comprehensive procedure is required, involving the removal of the surgical flaps and the infected bone. There is then a need to reconstruct the wall of the thoracic cavity with healthy tissue that allows good blood flow, by raising the surgical flaps from the chest or stomach and using them to fill the removed section. Doctors sometimes have to use more complex flaps (such as the omentum from the stomach).

All patients receive post-surgery intravenous antibiotics. The length and type of treatment is dependent on the severity of the infection and the type of bacteria involved. Treatment may last up to six weeks if a bone infection is evident.

Doctors in the Unit sympathize with patients who, after undergoing complex cardiac surgery and beginning a process of recovery, find that their condition has worsened and they must endure more treatment or surgery. It is important to note that in most cases the complication does not cause any direct risk to the surgery on the artery or heart valves. Despite this, even a local infection can spread throughout the mediastinal regional and endanger the patient's wellbeing, as many of these patients are already unwell and weak. The Unit's attitude, therefore, is to immediately attend to any sign of infection and adapt the treatment to the severity of the infection and the condition and wishes of the patient. The main advantage in the Unit is the vast experience doctors have in different methods of treatment, all of which aim at total recovery with minimal risk.

Contact:

Center: 03-6973402

Appointments: 03-6974000

(Prior to their first visit to the clinic, patients must fax a letter of referral including a description of their medical condition to fax: 03-6973871)

Location:

Arison Hospitalization Tower, 12th Floor