Two-staged tactics of treatment of postoperative sternomediastinitis using technique of negative pressure followed by two-flap omentoplasty according to K. Yoshida

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Abstract

This article presents an observation of a clinical case in a patient with the postoperative sternomediastinitis. In cardio-thoracic surgery this complication ranges from 1 to 10 % [2, 3, 14, 16, 19] depending on who the work is done by and the ratio of deaths can reach up to 40 % [13]. Due to untimely diagnosis of the pyoinflammatory process in the tracheostomy orifice, the patient developed progressive instability of the sternum followed by sternomediastinitis.

A two-staged tactics of treatment of the postoperative sternomediastinitis using the technique of negative pressure followed by two-flap omentoplasty according to K. Yoshida in this case is the technique of choice for surgical treatment, which allows to restore the integrity of the chest wall frame in the shortest possible time and ensure tightness for the mediastinum. This technique is the most effective in the treatment of destructive forms of purulent complications of the sternum after a median sternotomy. The relevance and expediency of the use of omentoplasty is also justified from a financial and medico-social position, since the procedure reduces mortality among patients of this category, as well as the risk of severe disability at the able-bodied age.

About the authors

A. V. Kasatov

Perm Regional Clinical Hospital; E.A. Vagner Perm State Medical University

Email: mdminasyan@mail.ru

Candidate of Medical Sciences, Head of Department of Hospital Surgery, Chief Physician

Russian Federation, Perm

V. B. Arutyunyan

S.G. Sukhanov Federal Center for Cardiovascular Surgery

Email: mdminasyan@mail.ru

MD, PhD, Head of Cardiac Surgery Unit № 1

Russian Federation, Perm

Victor N. Minasian

Perm Regional Clinical Hospital; E.A. Vagner Perm State Medical University; S.G. Sukhanov Federal Center for Cardiovascular Surgery

Email: mdminasyan@mail.ru
ORCID iD: 0000-0001-6554-4998

cardiovascular surgeon, Cardiac Surgery Unit № 1

Russian Federation, Perm

A. S. Vronsky

E.A. Vagner Perm State Medical University; S.G. Sukhanov Federal Center for Cardiovascular Surgery

Author for correspondence.
Email: mdminasyan@mail.ru

cardiovascular surgeon, Cardiac Surgery Unit №2

Russian Federation, Perm

References

  1. Oganov R.G., Gerasimenko N.F., Pogosova G.V., Koltunov I.V. i dr. Profilaktika serdechno-sosudistyh zabolevanij: puti razvitiya. Kardiova-skulyarnaya terapiya i profilaktika 2011; 10 (3): 5–7 (in Russian).
  2. Serdechno-sosudistye zabole-vaniya: Informacionnyj byulleten' VOZ. Moscov 2017 (in Russian).
  3. SHal'nova S.A., Deev A.D. Ishe-micheskaya bolezn' v Rossii: raspro-stranennost' i lechenie (po dannym kliniko-epidemiologicheskih issledo-vanij). Terapevticheskij arhiv 2011; 83 (1): 7–12 (in Russian).
  4. Ishihara M., Fujino M., Ogawa H. Clinical Presentation, Management and Outcome of Japanese Patients With Acute Myocardial Infarction in the Troponin Era – Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J- MINUET). Circulation Journal 2015; 79 (6): 1255–1262.
  5. Vishnevskij A.A., Rudakov S.S., Milanov O.N. Hirurgiya grudnoj stenki. Moscow VIDAR, 2005; 301 (in Russian).
  6. Kohan E.P., Aleksandrov A.S. Posleoperacionnye mediastinity. Diagnostika i lechenie. Hirurgiya. ZHurnal im. N.I. Pirogova 2011; 9: 22–26 (in Russian).
  7. Heilmann C., Stahl R., Schneider C., Sukhodolya T. et al. Wound complications after median sternotomy: a single-centre study. Interactive CardioVascular and Thoracic Surgery 2013; 16: 643–648.
  8. Morgante A., Romeo F. Deep sternal wound infections: a severe complication after cardiac surgery. Il Giornale di chirurgia 2017; 38 (1): 33–36.
  9. Thorsteinsson D.T., Valsson F., Geirsson A., Gudbjartsson T. Major cardiac rupture following surgical treatment for deep sternal wound infection. Interact CardioVasc Thorac Surg 2013; 16 (5): 708–709.
  10. Graf K., Ott E. et al. Economic aspects of deep sternal wound infections. European Journal of Cardio-thoracic Surgery 2010; 37: 893–896.
  11. Kohan E.P., Asanov O.N., Po-tapov V.A. Optimizaciya diagnostiki, lecheniya i profilaktiki infekcion-nyh oslozhnenij sternotomnoj rany u kardiohirurgicheskih bol'nyh. Mate-rialy III Mezhdunarodnogo kongressa «Rany i ranevye infekcii». Moscow 2016; 172–174 (in Russian).
  12. Berríos-Torres S.I., Mu Y., Edwards J.R., Horan T.C., Fridkin S.K. Improved risk adjustment in public reporting: coronary artery bypass graft surgical site infections. Infect Control Hosp Epidemiol 2012; 33 (5): 463–469.
  13. Cayci C., Russo M., Cheema F.H. et al. Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg 2008; 61: 294–301.
  14. Dodds Ashley E.S., Carroll D.N., Engemann J.J. et al. Risk factors for postoperative mediastinitis due to methicillin-resistant staphylococcus aureus. Clin Infect Dis 2004; 38 (11): 1555–1560.
  15. Risnes I., Abdelnoor M., Almdahl S.M., Svennevig Jan L. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg 2010; 89: 1502–1510.
  16. Rogers S.O., Zinner M.J. The role of perioperative hyperglycemia in postoperative infections. Adv Surg 2009; 43: 103–109.
  17. D’Agostino D., Lacatena C. et al. Postoperative mediastinitis in cardiac surgery- pathophysiology risk factors and prevention. Acta Medica Mediterranea 2015; 31: 1311.
  18. Furgal A.A, Muratov R.M., SHCHava S.P. i dr. Sravnitel'naya ocenka postoyannogo i peremennogo rezhima vakuum-terapii v lechenii posleoperacionnyh sternomediastinitov u kardiohirurgicheskih bol'nyh. Klinicheskaya i eksperimental'naya hirurgiya. ZHurnal imeni akademika B.V. Petrovskogo 2019; 7 (2): 71–78 (in Russian).
  19. Adyshirin-Zade E.E., SHadrin S.A., Andreev I.S., Frolov E.V. Hirur-gicheskoe lechenie bol'nyh so sterno-mediastinitami posle operacii aor-tokoronarnogo shuntirovaniya. Inno-vacionnye tekhnologii v lechenii ran i ranevoj infekcii: materialy konfe-rencii. Saint Petersburg 2015; 88–90 (in Russian).
  20. van Wingerden J.J., Coret M.E., van Nieuwenhoven C.A., Totte E.R. The laparoscopically harvested omental flap for deep sternal wound infection. Eur J Cardiothorac Surg 2010; 37: 87–92.
  21. Vyas R.М., Prsic A., Orgill D.P. Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage. Plast Reconstr Surg 2013; 13: 544–552.

Supplementary files

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2. Fig. 1. Stages of the operation: 1 - tracheostomy hole; 2 - polypropylene sponge with a film for vacuum aspiration; 3 - drainage tube for vacuum aspiration; 4 - distal, perforated part of the tubular drainage

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3. Fig. 2. The process of excising the edges of the wound to healthy, capable of tissue regeneration (a). The surface of the sternum, ready for plastic interventions, with visualized multiple transverse fractures (b)

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4. Fig. 3. The use of the LigaSure device to isolate the omental flap (a), revision of the selected flap for further rotation and relocation to the sternum defect (b)

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Copyright (c) 2021 Kasatov A.V., Arutyunyan V.B., Minasian V.N., Vronsky A.S.

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