I A Vinokurov, Yu V Belov, D G Tagabilev, S A Yusupov
{"title":"[Postoperative sternomediastinitis: morphology of lesion, treatment strategy].","authors":"I A Vinokurov, Yu V Belov, D G Tagabilev, S A Yusupov","doi":"10.17116/hirurgia202407178","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.</p><p><strong>Material and methods: </strong>There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients - heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2-3 - 19 (42.2%), type 4 - 4 (8.8%), type 5 - 11 (24.5%) patients.</p><p><strong>Results: </strong>Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1<sup>st</sup> group, 14 (73.7%) ones of the 2<sup>nd</sup> group, 4 (100%) patients of the 3<sup>rd</sup> group and 2 (18.2%) patients of the 4<sup>th</sup> group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2<sup>nd</sup> group and 1 (25%) patient in the 3<sup>rd</sup> group.</p><p><strong>Conclusion: </strong>The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"78-84"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/hirurgia202407178","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach.
Material and methods: There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients - heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2-3 - 19 (42.2%), type 4 - 4 (8.8%), type 5 - 11 (24.5%) patients.
Results: Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1st group, 14 (73.7%) ones of the 2nd group, 4 (100%) patients of the 3rd group and 2 (18.2%) patients of the 4th group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2nd group and 1 (25%) patient in the 3rd group.
Conclusion: The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.