Postoperative sternomediastinitis: morphology of lesion, treatment strategy

Vinokurov I.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-0433-2523

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Tagabilev D.G.

Petrovsky Russian Research Center of Surgery

ORCID: 0000-0003-2823-635X

Yusupov S.A.

Petrovsky National Research Center of Surgery

ORCID: 0009-0000-5912-3249

Postoperative sternomediastinitis: morphology of lesion, treatment strategy

Authors:

Vinokurov I.A., Belov Yu.V., Tagabilev D.G., Yusupov S.A.

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Journal: Pirogov Russian Journal of Surgery. 2024;(7): 78‑84

DOI: 10.17116/hirurgia202407178

Downloaded: 9

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To cite this article:

Vinokurov IA, Belov YuV, Tagabilev DG, Yusupov SA. Postoperative sternomediastinitis: morphology of lesion, treatment strategy. Pirogov Russian Journal of Surgery. 2024;(7):78‑84. (In Russ.)
https://doi.org/10.17116/hirurgia202407178

Подписка 2025 (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.

MATERIAL AND METHODS

There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients — heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2—3 — 19 (42.2%), type 4 — 4 (8.8%), type 5 — 11 (24.5%) patients.

RESULTS

Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1^st group, 14 (73.7%) ones of the 2^nd group, 4 (100%) patients of the 3^rd group and 2 (18.2%) patients of the 4^th group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2^nd group and 1 (25%) patient in the 3^rd group.

CONCLUSION

The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.

Keywords:

sternomediastinitis

sternotomy

cardiac surgery

Authors:

Vinokurov I.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-0433-2523

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Tagabilev D.G.

Petrovsky Russian Research Center of Surgery

ORCID: 0000-0003-2823-635X

Yusupov S.A.

Petrovsky National Research Center of Surgery

ORCID: 0009-0000-5912-3249

Received:

23.10.2023

Accepted:

28.01.2024

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