Treatment of complicated sternal wounds

Abstract

Background. The healing of wounds in the sternum has its own characteristics, which is most relevant, since the median sternotomy is the main operative approach in cardiothoracic surgery. Local infectious complications of wounds in this zone occur in 0.4–6 % of patients. The basic purpose is to evaluate the effectiveness of two-stage in comparison with the one-stage method of plastic closure of complicated sternal wounds based on the active surgical approach to their treatment and the use of local vacuum drainage. Materials and methods. The description of the early sternomediastinitis after cardiothoracic and trauma surgery in 11 patients. Results. Complication was the cause for using open method of management with negative pressure therapy in combination with antibacterial treatment. Foam sponge was used as absorbent material. Negative pressure of 70–90 mmHg was created using aspirator. The bandage was changed every 3–4 days. A rapid growth of granulating tissue, a significant reduction in the wound surface, and an improvement in the patient’s emotional state were noted. Discharge from the hospital in a satisfactory condition occurred on the 14th day after the beginning of the use of vacuum drainage system. The dependence of lipid peroxidation activation on the severity of exudative and destructive inflammation manifestations has been established, thereby suggesting the possibility of using the values of free radical oxidation as markers. The application of skin grafts or flaps were required due to complete wound closure with granulations with the formation of a full scab of the anterior thoracic wall. Conclusions. When using vacuum therapy in patients with infectious complications of sternal wounds, the risk of recurrence and the duration of treatment are reduced