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Vinokurov I.A.

Petrovsky National Research Center of Surgery

Ivanov K.P.

Petrovsky National Research Center of Surgery

Tagabilev D.G.

Petrovsky Russian Research Center of Surgery

Bessmertnaya V.S.

Petrovsky National Research Center of Surgery

Pshonkin D.N.

Petrovsky National Research Center of Surgery

A new paradigm for the treatment of sternomediastinitis

Authors:

Vinokurov I.A., Ivanov K.P., Tagabilev D.G., Bessmertnaya V.S., Pshonkin D.N.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2023;(12): 52‑58

DOI: 10.17116/hirurgia202312152

Views: 788

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Table of contents

To cite this article:

Vinokurov IA, Ivanov KP, Tagabilev DG, Bessmertnaya VS, Pshonkin DN. A new paradigm for the treatment of sternomediastinitis. Pirogov Russian Journal of Surgery. 2023;(12):52‑58. (In Russ.)
https://doi.org/10.17116/hirurgia202312152

Подписка 2025 (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
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OBJECTIVE

To analyze the results of simultaneous surgical treatment of sternomediastinitis compared to stage-by-stage approach.

MATERIAL AND METHODS

The study included 27 patients between October 2022 and March 2023. All patients underwent heart surgery through median sternotomy. There were 11 (40.7%) women and 16 (59.3%) men. Mean age of patients was 68.4±9.8 years. All patients were divided into 2 groups: 12 patients underwent partial necrectomy and vacuum wound therapy (or long-term dressings) before surgery (group 1), 15 patients underwent surgery without prior conservative treatment (group 2).

RESULTS

The most common causative agent of infection was staphylococcus (48.1%). In all patients, we found histological signs of osteomyelitis. Preoperative clinical status was similar in both groups. There were differences in the following indicators: C-reactive protein upon admission — 74.9±18.6 versus 94.8±23.8 mg/l, procalcitonin — 0.13 [0.02; 1.43] versus 0.21 [0.02; 0.94] ng/ml. Postoperative outcomes were similar in both groups. Mortality was 8.3% (n=1) and 13.3% (n=2), respectively.

CONCLUSION

Simultaneous combined surgical treatment (sequestrectomy + muscle flap grafting) demonstrates optimal results in the treatment of sternomediastinitis.

Keywords:

sternomediastinitis
vacuum therapy
muscle flap grafting
one-stage treatment

Authors:

Vinokurov I.A.

Petrovsky National Research Center of Surgery

Ivanov K.P.

Petrovsky National Research Center of Surgery

Tagabilev D.G.

Petrovsky Russian Research Center of Surgery

Bessmertnaya V.S.

Petrovsky National Research Center of Surgery

Pshonkin D.N.

Petrovsky National Research Center of Surgery

Received:

29.08.2023

Accepted:

20.09.2023

List of references:

  1. Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, Hentschel B, Schmitt DV, Mohr FW, Diegeler A. Mediastinitis and cardiac surgery — an updated risk factor analysis in 10,373 consecutive adult patients. Thoracic and Cardiovascular Surgery. 2002;50(2):87-91.  https://doi.org/10.1055/s-2002-26691
  2. Vishnevskyi AA, Pechetov AA. Asymmetric sternotomy as a risk factor for the development of postoperative sternomediastinitis. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2012;2:19-23. (In Russ.).
  3. Josanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. European Journal of Cardio-Thoracic Surgery. 2002;21(5):831-839.  https://doi.org/10.1016/s1010-7940(02)00124-0
  4. Akchurin RS, Shiryaev AA, Galyautdinov DMet al. Prevention and treatment of infectious diseases during myocardial revascularization. Grudnaya khirurgiya. 1992;(5):9-11. (In Russ.).
  5. Lednev PV, Belov IuV, Stonogin AV, Lysenko AV, Salagaev GI. Postoperative sternomediastinitis. Khirurgiya. Zhurnal im. N.I. Pirogova. 2018;(4):84-89. (In Russ.). https://doi.org/10.17116/hirurgia2018484-89
  6. Ivantsov SM, Soynov IA, Omelchenko AYu, Nichay NR, Kulyabin YuYu, Gorbatykh AV, Voitov AV, Gorbatykh YuN. Vac-therapy: a new method for the treatment of mediastinitis in newborns. Medical Almanac. 2016;2(42):102-104. (In Russ.).
  7. Qiu X, Sun X, Huang G. Immediate flap increases patient safety for deepsternal wound infection: A meta-analysis. International Wound Journal. 2023;1‐8.  https://doi.org/10.1111/iwj.14207
  8. Kaláb M, Karkoška J, Kamínek M, Šantavý P. Successful three-year outcome in a patient with allogenous sternal bone graft in the treatment of massive post-sternotomy defects. International Journal of Surgery Case Reports. 2015;7C:6-9.  https://doi.org/10.1016/j.ijscr.2014.12.027
  9. Prifti E, Demiraj A, Xhaxho R. Modified Port-Access Technique for the Treatment of Aortic Dissection after Previous Cardiac Surgery. Texas Heart Institute Journal. 2017;44(3):202-204.  https://doi.org/10.14503/THIJ-16-5800
  10. Copeland H, Newcombe J, Yamin F, Bhajri K, Mille VA, Hasaniya N, Bailey L, Razzouk AJ. Role of Negative Pressure Wound Care and Hyperbaric Oxygen Therapy for Sternal Wound Infections After Pediatric Cardiac Surgery. World Journal for Pediatric and Congenital Heart Surgery. 2018;9(4):440-445.  https://doi.org/10.1177/2150135118772494
  11. Lentini S, Monaco F, Tancredi T, Perrotta S, Savasta M, Gaeta R. Surgical treatment of pericardial cyst through median sternotomy. Minerva Surgery. 2009;64(1):105-109. 
  12. Buja A, Zampieron A, Cavalet S, Chiffi D, Sandonà P, Vinelli A, Baldovin T, Baldo V. An update review on risk factors and scales for prediction of deep sternal wound infections. International Wound Journal. 2012;9(4):372-386.  https://doi.org/10.1111/j.1742-481X.2011.00896.x
  13. Hulman M, Bezak B, Artemiou P, Cikrai R. Wound infections after median sternotomy treated by VAC therapy, summary of results, and risk factor analysis. Bratislava Medical Journal. 2017;118(12):736-739. 
  14. Vachev AN, Koryttsev VK, Adyshirin-Zade EE, Gladyshev VV, Kalimullin HA. Differentiated approach in the treatment of patients with sternomediastinitis after cardiac surgery. Grekov’s Bulletin of Surgery. 2018;177(2):60-63. (In Russ.). https://doi.org/10.24884/0042-4625-2018-177-2-60-63

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