SURGICAL TREATMENT OF COMPLICATIONS AFTER STERNOTOMY
Summary. The article presents materials of laboratory and instrumental diagnostics of 44 patients with sternal osteomyelitis and comparative treatment with VAC - therapy and open method. Diagnosis was verified by multispiral computed tomography. Ultrasound showed the best results to control the cleaning and healing of sternotomy wounds. The bacterial spectrum showed a predominance of gram-positive microflora in 52.38 % of patients. The use of VAC therapy reduced the duration of hospitalization of patients from (20,3±2,7) to (13,6±5,8) days.
Materials and methods. We analyzed the results of treatment of 22 patients who were treated at the State Institution “V.T. Zayceva IGUS NAMSU “in the period from 2014 to 2020 with osteomyelitis of the sternum (OS) after sternotomies. The material for the bacterial study was the isolation of a sternal wound. The antibiotic susceptibility of the isolated bacterial cultures was studied by disco-diffusion method and on agar. Diagnosis of multislice computed tomography (MSCT) was performed using Toshiba Aquilion 64 (Japan).
Results and discussion. Wound infection was detected in 42 patients out of 44 examined. A total of 34 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. In 14.28 % of cases there was contamination of S. epidermidis. E. coli and K. pneumonia 14.28 and 9.52 %, respectively. The most effective in vitro were lincomycin and especially carbopenems (imipenem).
Among the instrumental studies we performed fistulography, ultrasound diagnostics (ultrasound) and MSCT.
We used VAC therapy in 31 patients and in 13 patients by bandaging depending on the stage of the wound process. The duration was (4.7 ± 1.3) days.
There was a decrease in the duration of wound cleansing: with superficial sternal infection — (12.8 ± 5.2) and (4.7 ± 1.3) days; with deep sternal infection — (25.3 ± 1.4) and (10.9 ± 2.2) days; term of hospitalization of patients with superficial sternal infection — (27.3 ± 5.6) and (13.6 ± 5.8) days; term of hospitalization of patients with deep sternal infection — (41.2 ± 3.5) and (20.3 ± 2.7) days.
Conclusions. 1. In the diagnosis of OS should be preferred MSCT, which allows to verify the diagnosis in up to 99 % of cases, and the use of ultrasound to monitor the cleaning and healing of sternotomy wounds. The use of VAC therapy reduced the duration of hospitalization of patients from (20,3±2,7) to (13,6±5,8) days.
2. Prifti E, Demiraj A, Xhaxho R. Modified Port-Access Technique for the Treatment of Aortic Dissection after Previous. Cardiac Surgery. 2017; Tex Heart Inst. J. 2017;6. 1.44 (3). 202-04.
3. Kirmani BH, Jones SG, Malaisrie SC, Chung DA, Williams RJ. Limited versus full sternotomy for aortic valve replacement. Cochrane Database Syst Rev. 2017;4,10.4. CD0117936.
4. Suzuki K, Ishigami N, Akuzawa S. Тreatment of Mediastinitis after Open Heart Surgery Using Negative Pressure Wound Therapywith Irrigation. Kyobu Geka. 2018;71(11).916-18.
5. Onan IS, Yildiz O, Tüzün B, Timur B, Haydin S. Vacuum- Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single-Center Experience. Artif Organs. 2018;10.3.
6. Copeland H, Newcombe J, Yamin F, Bhajri K, Mille VA, Hasaniya N, Bailey L, Razzouk AJ. Role of Negative Pressure Wound Care and Hyperbaric Oxygen Therapy for Sternal Wound Infections After Pediatric Cardiac Surgery. World J. Pediatr Congenit Heart Surg. 2018;7,9 (4).440-45.
7. Hulman M, Bezak B, Artemiou P, Cikrai R. Wound infections after median sternotomy treated by VAC therapy, summary of results, and risk factor analysis. Bratisl Lek Listy. 2017;118(12).736-39.