الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Mediastinitis is the inflammation of the mediastinum, the area between the lungs; it contains heart, the large blood vessels, trachea and esophagus, the thymus gland and connective tissue. Mediastinitis may occur suddenly or may develop slowly and worsen over time. Most cases occur in patients who had an open chest surgery. Mediastinitis occurs in less than 5% of all patients who had open chest surgery. Patients who have a tear in the esophagus from excessive vomiting, trauma or endoscopy may develop mediastinitis.
Mediastinitis is a life threatening condition with an extremely high mortality rate if recognized late or treated improperly. Although long recognized as a complication of certain infectious diseases, most cases are associated with cardiac surgery. This complication affects 1-2% of thee patients. Although small in proportional terms, the actual number of patients affected by mediastinitis is substantial. This significantly increases mortality and cost.
Prior to the development of modern cardiovascular surgery, most cases of mediastinitis arose from either perforation of esophagus. Rarely, primary infections of the mediastinum developed as a result of penetrating trauma or hematogenous spread of infection. However in modern practice, most cases of mediastinitis are postoperative complication of cardiovascular or other thoracic surgical procedures.
The exact pathogenic mechanisms underlying postoperative Mediastinitis remain unknown; multiple factors might play a role. Some authors favor the intraoperative contamination; where as other studies demonstrated that endogenous bacteria might be pathogenetically involved because preoperative intranasal antibiotic treatment significantly reduced the incidence of Mediastinitis.
The majority of patients with postoperative Mediastinitis have a monomicrobial infection. The bacteria that was isolated from the mediastinal wound was staph aureus which is the common and staph epidermidis and others like klebsiella, E. coli and psudomonus.
Regarding to treatment of patients with Mediastinitis, they are first treated with aggressive antibiotic treatment, and if the treatment failed, VAC therapy is indicated, if both failed surgical treatment is the last choice. This can be done by debriment of the infected wound and bone and removal of sternal wire and rewiring.if all failed ,reconstructive surgery is indicated by using muscle flaps or synthetic prosthesis.