Post-sternotomy mediastinitis is a severe complication of cardiac surgery and accompanied by high mortality and cost of treatment. To date, there are no large clinical trials defining treatment of these patients. In this study the authors offer early postoperative wound sanitation, use of vacuum drainage in all cases and surgical repair with local tissues. Sternal destruction is cured by osteosynthesis with wire sutures and perforated metal plates. Proposed algorithm showed low incidence of reccurent wound infection, mortality and duration of treatment.
The results of treatment of 701 adult patients with congenital heart diseases from 1987 to 1997 are analyzed. As many as 248 operations with general postoperative lethality 3,2% are made. It is concluded on the necessity of improving the diagnosis of congenital heart diseases in children, especially in rural regions in relation to the high rate of inopportune revealing heart diseases resulting in the increase of the number of inoperable patients with pronounced pulmonary hypertension. The presence of symptoms or pronounced blood escape out of the left article into the right one in the absence of pulmonary hypertension is considered the indication to the radical correction of secondary defect of interatrial septum in adults. The radical heart disease correction in conditions of moderate hypotermy without artificial blood circulation is recommended in small secondary defect of interatrial septum
Aim. Comparison of the efficacy of different sternal closure techniques for patients with poststernotomy mediastinitis.
Methods. From 2011 till 2016 29 patients after cardiothoracic surgeries complicated by poststernotomy mediastinitis and sternal dehiscence were observed. Depending on the used technique of re-osteosynthesis the patients were divided into 3 groups. In the group 1 re-osteosynthesis was performed with steel surgical wire, in group 2 - with titanium nickelide staples, and in group 3 - with developed by authors modernized U-shaped wire suture on the padding consisting of perforated metal sheet (titanium mesh). All patients during pre-operative period had vacuum wound drainage performed. In some patients during re-osteosynthesis vancomycin paste was used.
Results. The rate of sternal dehiscence recurrence in the group 1 was 30%, in group 2 - 12.5% and in group 3 - 9% (р1-2=0.08, р1-3=0.04, р2-3=0.2). The average hospital stay in group 1 was 51 days, in group 2 - 27 days and in group 3 - 24 days (р1-2=0.05, р1-3=0.07, р2-3=0.4). In inharmed bone tissue of the sternum titanium nickelide staples use decreases the risk of recurrent sternal dehiscence by 17.5% compared to widely used osteosynthesis method with the use of steel wire.
Conclusion. Osteosynthesis method suggested by the authors demonstrated its reliability in 91% of cases; use of vancomycin paste during re-osteosynthesis allowed avoiding recurrent wound infection both in short- and long-term periods in 100% of cases.
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