Choice of sternal closure technique in patients with poststernotomy mediastinitis

Abstract

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.