Authors
Potapov V.A.1, Kohan E.P.2, Asanov O.N.1, Musailov V.A.1
1 Military Medical Academy named after S. M. Kirov, filial branch, Moscow
2 The 3-rd Central Military Clinical Hospital named after A.A. Vishnevsky, Krasnogorsk
Abstract
The purpose of the study. To improve the results of treatment of patients with deep sternal infection, using the step-by-step principle of surgical tactics and a combination of vacuum-assisted closure therapy and bacteriophages.
Materials and methods. The work is based on the materials of the examination and treatment of 88 patients with deep sternal wound infection from 2010 to 2019. Surgical management of patients was divided into three types, depending on the study group, the patient's condition and the nature of the course of postoperative sternomediastinitis: one-stage (applied retroactively), two-stage and three-stage approaches. The algorithm of complex treatment of deep sternal wound infection was improved by using vacuum-assisted hardware dressings in combination with local and oral application of bacteriophages at the stage of preparation of a poststernotomic wound for closure.
Results. The proposed method allowed not only to reduce the duration of treatment of patients with postoperative sternomediastinitis, but also to reduce the frequency of relapses by 29.6% compared to the group using the "traditional" approach (p1-3<0.05) and by 10% compared to the group using monocomponent vacuum therapy (p2-3=0.05). The mortality rate among the patients of the complex treatment group was two times lower than in the other groups and amounted to 5.0±0.1% (p<0.05).
Conclusion. The proposed algorithm for the treatment of cardiac surgery patients with deep sternal wound infection is based on the use of local negative pressure on the wound process and the universality, evolutionary specificity of bacteriophages in the fight against bacterial pathogens, which contributes to a comprehensive increase in the effectiveness of treatment of patients with such a complication.
Keywords: deep sternal wound infection, postoperative sternomediastinitis, VAC therapy, bacteriophages.
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