Comparative analysis of the results of plastic reconstructive phase of treatment in patients with deep postoperative sternomediastinitis

Background. The high frequency of complications, as in the place of the fence material and the recipient bed, the limited indications for most modern methods used in the reconstructive phase of the treatment of postoperative sternomediastinitis dictate the necessity of finding alternative ways of plastic operations for closure of defects of the chest wall.

Aim – analysis of the results of reconstructive plastic phase of treatment in patients with postoperative sternomediastinitis and evaluation of the results of surgery with the method of correction (plastic surgery with autocanum or reosteosynthesis of sternum with different locks).

Methods. А cohort study model was chosen for the purpose of retrospective analysis of medical records of patients treated for postoperative sternomediastinitis from 01.01.2010 to 31.12.2018. The immediate objective of the hospitalization of the patients was the relief of sternomediastinitis, confirmed by radiological and/or microbiological diagnostic methods.

Results. The study included 75 patients, of which 25 patients underwent reosteosynthesis of the sternum with fixators from inert materials, 6 patients underwent thoracomyoplasty, 40 patients underwent plastic surgery with deepidermized skin-fascial flaps. 4 patients with the most significant destruction of bone tissue, extensive purulent wound, were plasticized with skin-fascial thoracoabdominal flap. Sternomediastinitis remission was achieved in 68 patients (90.6%) are included in the study.

Conclusion. The study did not reveal a significant difference in the frequency of remission depending on the method of surgical intervention at the reconstructive plastic phase of treatment. The choice of tactics of surgery was dictated by specific indications for the operation. Thus, in the presence of an extensive defect of the chest wall, a method of plastic surgery with a skin-fascial thoracoabdominal flap was used. At the same time, in the most clinically favorable situations, the method of choice was reosteosynthesis with inert materials.

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