Postoperative sternomediastinitis: morphology of lesion, treatment strategy

• Published in: Hirurgija (Moskva) no. 7; p. 78
• Main Authors: Vinokurov, I A, Belov, Yu V, Tagabilev, D G, Yusupov, S A
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2024
• Subjects: Aged; C-Reactive Protein - analysis; C-Reactive Protein - metabolism; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Debridement - methods; Female; Humans; Male; Mediastinitis - diagnosis; Mediastinitis - etiology; Mediastinitis - therapy; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Sternotomy - adverse effects; Sternotomy - methods; Sternum - pathology; Sternum - surgery; Surgical Wound Infection - diagnosis; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - etiology; cardiac surgery; sternomediastinitis; sternotomy
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202407178

To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.
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.
Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1
group, 14 (73.7%) ones of the 2
group, 4 (100%) patients of the 3
group and 2 (18.2%) patients of the 4
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
group and 1 (25%) patient in the 3
group.
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.