Candidal Mediastinitis Successfully Treated Using Omentum Flap and Split‐Thickness Meshed Skin Flap Following Open‐Heart Surgery: A Case Report

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 blood supply and adequate volume for filling. Standard skin suturing was impossible because of the fragility and near‐complete absence of the sternum. Instead, a large mesh‐like free skin graft was created for coverage, which yielded favorable results. Twelve months after the surgery, the wound healed completely. His cardiac function remained favorable, with a left ventricular ejection fraction of 60%; he reported no pain or discomfort. This case indicates that a gradual approach to control wound infections and ensure tissue closure is potentially among the most effective strategies for managing deep wound infections caused by C. albicans .