Experience of surgical treatment of internal postoperative complications after median sternotomy

Abstract

Aim. To assess the results of treatment in patients with deep postoperative complications after median sternotomy. Methods. The study included 33 patients: 25 males and 8 females (mean age 58.63±6.29 and 60.3±12.9 years, respectively). X-ray, helical computed tomography of the chest, sternum and anterior mediastinum ultrasound, echocardiography, pulmonary function test, bacteriology, clinical and laboratory tests were used to assess pre- and post-operative conditions of the patients. Fistulography and sternum scintigraphy with 99mTc-technetril were performed if necessary. Complications included anterior mediastinitis, sternal osteomyelitis, sternal diastasis, chest bones instability and sternal fragmentation. Some patients also developed superficial wound infection together with internal complications. The first stage of treatment included secondary surgical debridement, metal suture osteosynthesis, surgical sternal reconstruction by titanium nickelide plexiform tubulous implant and VRAM flap thoracomyoplasty. Results. Secondary surgical debridement was performed as the first stage of treatment in 51.51% patients (n=17) including 29.4% patients who were operated for the second time. Metal suture osteosynthesis as step 1 surgery was performed in 33.3% of patients (n=11); 54.5% of patients (n=6) were re-operated. Metal suture or clamp osteosynthesis did not lead to the sternal reconstruction in 80% of cases. Chest surgical reconstruction by titanium nickelide implants as step 1 surgery was performed in 12.12% of patients (n=4) resulting in chest stabilization, sternal diastasis elimination, and correction of sterno-mediastinitis. VRAM flap thoracomyoplasty was performed in 1 patient. Conclusions. The step-wise approach surgery was preferable (step 1 - secondary surgical debridement and antibiotics, step 2 - surgical sternal reconstruction). Sternal reconstruction by titanium nickelide implants is indicated for treating patients without severe sternal fragmentation and offers good early results.