Vinokurov IA, Ivanov KP, Tagabilev DG, Bessmertnaya VS, Pshonkin DN. [A new paradigm for the treatment of sternomediastinitis].
Khirurgiia (Mosk) 2023:52-58. [PMID:
38088841 DOI:
10.17116/hirurgia202312152]
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Abstract
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.
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