Combined VAC system and thoracoplasty for purulent-destructive sternomediastinitis in a senile patient with total sternal fracture

A.L. Egizekov

Modern Medicine Center “Mediterra”

ORCID: 0000-0001-7979-2239

K.N. Kuatbekov

Modern Medicine Center “Mediterra”

ORCID: 0000-0002-2679-5097

A.E. Tuganbaev

Modern Medicine Center “Mediterra”

N.B. Baizhigitov

Modern Medicine Center “Mediterra”

ORCID: 0000-0001-5041-4277

A.V. Mishin

Modern Medicine Center “Mediterra”

ORCID: 0000-0003-2858-6181

Combined VAC system and thoracoplasty for purulent-destructive sternomediastinitis in a senile patient with total sternal fracture

Authors:

A.L. Egizekov, K.N. Kuatbekov, A.E. Tuganbaev, N.B. Baizhigitov, A.V. Mishin

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(3): 326‑331

DOI: 10.17116/kardio202316031326

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To cite this article:

Egizekov AL, Kuatbekov KN, Tuganbaev AE, Baizhigitov NB, Mishin AV. Combined VAC system and thoracoplasty for purulent-destructive sternomediastinitis in a senile patient with total sternal fracture. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(3):326‑331. (In Russ.)
https://doi.org/10.17116/kardio202316031326

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Widespread sternotomies in cardiac surgery proportionally increase the number of infectious complications. The most severe one is purulent-destructive sternomediastinitis. Negative pressure therapy (vacuum assisted closure — VAC) is confidently included into the standards of treatment of almost any infectious processes. We report successful treatment of purulent-destructive sternomediastinitis in a 75-year-old patient after coronary artery bypass surgery and sternotomy closure by Robicsek. Combined VAC system and thoracoplasty with large pectoral muscle flaps were used. We applied AND-aspirator with local negative pressure of 115-125 mm Hg. The patient underwent installation of combined VAC and flow-flushing system, 15 alternating changes of VAC system, 4 installations of metal constructions and final thoracoplasty with flaps of both large pectoral muscles within 3 months. Ultrasound and computed tomography were performed to determine topography of lesion and severity of tissue destruction. VAC therapy reduced bacterial contamination and stimulated tissue regeneration. Major pectoralis muscle flaps are advisable for sternal defect closure in elderly patients with complicated purulent-destructive sternomediastinitis and deficit of other acceptable flaps.

Keywords:

mediastinitis

vacuum assisted closure system

thoracoplasty

clinical case

Authors:

A.L. Egizekov

Modern Medicine Center “Mediterra”

ORCID: 0000-0001-7979-2239

K.N. Kuatbekov

Modern Medicine Center “Mediterra”

ORCID: 0000-0002-2679-5097

A.E. Tuganbaev

Modern Medicine Center “Mediterra”

N.B. Baizhigitov

Modern Medicine Center “Mediterra”

ORCID: 0000-0001-5041-4277

A.V. Mishin

Modern Medicine Center “Mediterra”

ORCID: 0000-0003-2858-6181

Received:

21.01.2022

Accepted:

22.06.2022

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