Authors
Levchuk A.L., Fedyk O.V., Katkov A.A., Gudymovich V.G., Ablitsov A.Y., Belyanin A.O., Miminoshvili L.G., Malsagova D.B.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The incidence of infectious complications after sternotomy in cardiac surgery is 4%, including deep lesions with the development of anterior mediastinitis and osteomyelitis of the sternum. The solution to the problem of ensuring this formidable risk in cardiac surgery, current issues determine their early diagnosis and the choice of surgical tactics, which are developed by a number of factors: the severity of the patient’s initial condition, the duration and conclusion of cardiac surgery, the timing of development and prevalence of the inflammatory process, as well as the diagnostic and therapeutic capabilities of the medical hospital.
The present clinical observation indicates that purulent sternomediastinitis in the form (type III according to the classification of Slesarenko S.S. (2005)) requires a staged surgical tactic, including: active surgical debridement of wounds using local negative pressure technologies, modern pharmacological agents of both (epidermal growth factor) and general (targeted antibiotic therapy) effects, followed by a reconstructive and restorative stage (after stopping the inflammatory process), performing restoration of the sternum and restoration of the soft tissue defect of the anterior chest wall.
Thus, a staged personalized approach to visiting a patient with late purulent sternomediastinitis allows achieving a positive result while maintaining a high level of quality of life for the patient.
Keywords: deep purulent sternomediastinitis, osteomyelitis of the sternum, staged surgical treatment.
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