Authors
Potapov V.A., Bryusov P.G., Surova M.V., Musailov V.A.
Military Medical Academy named after S. M. Kirov, filial branch, Moscow
Abstract
The authors, based on the materials of russian and foreign researchers, give a short review of the development of sternal osteosynthesis and chest wall reconstruction after treatment of deep sternal wound infection. Reliable fixation of sternum fragments plays a leading role in the prevention of relapses of sternomediastinitis. The methods used for sternotomy re-closure vary from wire sternal suture in various ways to using rigid plate fixation by screws, thermoreactive clips and the sternal ZipFixTM system. The choice of the method of plastic surgery of the anterior chest wall depends on the general condition of the patient, the nature of the concomitant pathology, the volume of purulent-destructive damage to the surrounding tissues, the radicality of the previous surgical treatment, as well as on the experience and specialization of the surgeon. The article emphasizes the priority of the plastic reserve of local tissues with the participation of pectoralis major muscle flaps, the limitation of indications for omentoplasty.
Keywords: deep sternal wound infection, postoperative sternomediastinitis, sternal osteosynthesis, thermoreactive clips, myoplasty, pectoralis major muscle flap, omentoplasty.
References
1. Bokeriya LA. Modern trends in the development of cardiovascular surgery (20 years later). Annaly hirurgii. 2016; 21(1-2): 10-18. (In Russ). doi: 10.18821/1560-9502-2016-21-1-10-18.
2. Lednev PV, Belov YV, Stonogin AV, et al. Postoperative sternomediastinitis. Hirurgija. Zhurnal im. N.I. Pirogova. 2018;(4): 84-89. (In Russ). doi: 10.17116/hirurgia2018484-89.
3. Badawy MA, Shammari FA, Aleinati T et al. Deep sternal wound infection after coronary artery bypass: How to manage? Asian Cardiovasc. Thorac. Ann. 2014; 22(6): 649-654. doi: 10.1177/0218492314536106.
4. Vishnevskij AA, Rudakov SS, Milanov NO. Hirurgiya grudnoj stenki. Moscow: Vidar, 2005. (In Russ).
5. Porkhanov VA, Polyakov IS, Kovalenko AL, Sirota AA. Sovremennaya taktika lecheniya posleoperatsinnykh sternomediastinitov s ispolzovaniyem vakuumnykh povyazok. In: Proceedings of the 1st International. congress “Wounds and wound infections”; Moscow, 2012: 277-278. (In Russ.)
6. Morgante A, Romeo F. Deep sternal wound infections: a severe complication after cardiac surgery. G Chir. 2017; 38(1): 33-36. doi: 10.11138/gchir/2017.38.1.033.
7. Bonacchi M, Prifti E, Bugetti M, et al. Deep sternal infections after in situ bilateral internal thoracic artery grafting for left ventricular myocardial revascularization: predictors and influence on 20-year outcomes. J Thorac Dis. 2018; 10(9): 5208-5221. doi: 10.21037/jtd.2018.09.30.
8. Goryunov SV, Abramov IS, CHapar’yan BA, et al. Rukovodstvo po lecheniyu ran metodom upravlyaemogo otricatel’nogo davleniya. Moscow: Aprel’. 2013. (In Russ.)
9. Furgal AA, Muratov RM, Shchava SP, et al. Comparative evaluation of the continuous and intermittent modes of vacuum therapy for the management of deep sternal wound infection after cardiac surgery. Klinicheskaya i eksperimentalnaya khirurgiya. Zhurnal im. akademika B.V. Petrovskogo. 2019; 7(2): 71-78. (In Russ). doi: 10.24411/2308-1198-2019-12010.
10. Ovakimyan AG, Kazaryan SF, Shatakhyan MP, et al. Faktory riska razvitiya infektsionnykh oslozhneniy v oblasti khirurgicheskogo vmeshatelstva v period prebyvaniya v statsionare i posle vypiski iz nego u patsiyentov s koronarnym shuntirovaniyem na rabotayushchem serdtse. Grudnaya i serdechno-sosudistaya khirurgiya. 2009; 3: 32-35. (In Russ).
11. De Paulis R, de Notaris S, Scaffa R et al. The effect of bilateral Internal thoracic artery harvesting on superficial and deep sternal infection: The role skeletonization. J. Thorac. Cardiovasc. Surg. 2005; 129(3): 536-543. doi: 10.1016/j.jtcvs.2004.07.059.
12. Galeyev NA. Rezultaty razlichnykh vidov fiksatsii grudiny posle operatsiy na serdtse i aorte. [dissertation] Moscow; 2017. (In Russ). [URL]
13. Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J. Thorac. Cardiovasc. Surg. 1977; 73(2): 267-268.
14. Vishnevskiy AA, Pechetov AA, Dankov DV. Asymmetric sternotomy as factor of risk of postoperative sternomediastinitis. Grudnaya i serdechno-sosudistaya khirurgiya. 2012; (2):19-23. (In Russ).
15. Meeks MD, Lozekoot PW, Verstraeten SE, et al. Poststernotomy mediastinitis and the role of broken steel wires: retrospective study. Innovations (Phila). 2013; 8(3): 219–224. doi: 10.1097/IMI.0b013e3182a20e3c.
16. Pechetov AA. Metody soyedineniya grudiny razlichnymi materialami posle sredinnoy sternotomii. [dissertation] Moscow; 2010. (In Russ). [URL]
17. Robicsek F. Complication of midline sternotomy. Thoracic Surgery. 2002; 51: 1351-1392. doi:10.1016/B978-0-443-06861-4.50106-4.
18. Nazaryan KE. Khirurgicheskaya profilaktika oslozhneniy sredinnoy sternotomii posle operatsiy na serdtse. [dissertation] Moscow; 2012. (In Russ). [URL]
19. Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. Eur. J. CardioThorac. Surg. 2002; 21: 831-839. doi: 10.1016/s1010-7940(02)00124-0.
20. Riess FC, Awwad N, Hoffmann B, et al. A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy. Heart surg forum. 2004; 7(6): 87-92. doi: 10.1532/HSF98.200403114.
21. Franco S, Ana M. Herrera, Mauricio A, et al. Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population. Interact. Сardiovasc. Thorac. Surg. 2009; 8: 200-205. doi: 10.1510/icvts.2008.188136.
22. Sharma R, Puri D, Panigrahi BP, et al. A modified parasternal wire technique for prevention and treatment of sternal dehiscence. Ann. Thorac. Surg. 2004; 77: 210-213. doi: 10.1016/s0003-4975(03)01339-0.
23. Song DH, Lohman RF, Renucci JD, et al. Primary sternal plating in high-risk patients mediastinitis. Eur. J. Cardiothorac. surg. 2004; 26(2): 67-72. doi: 10.1016/j.ejcts.2004.04.038.
24. Dogan OF, Demircin M, Duman U, et al. The use of suture anchor for sternal nonunion as a new approach (Demicin-Dogan technique). Heart. surg. forum. 2005; 8(5): 6-9. doi: 10.1532/HSF98.20051024.
25. Gorbunov VA. Usovershenstvovaniye kompleksnogo lecheniya posleoperatsionnogo mediastinita u kardiokhirurgicheskikh patsiyentov. [dissertation] Nizhny Novgorod; 2019. (In Russ). [URL]
26. Allen KB, Thourani VH, Naka Y, et al. Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg. 2017; 153(4): 888-896. doi: 10.1016/j.jtcvs.2016.10.093.
27. Huh J, Bakaeen F, Chu D, et al. Transverse sternal plating in secondary sternal reconstruction. J Thorac Cardiovasc Surg. 2008; 136: 1476-1480. doi: 10.1016/j.jtcvs.2008.03.051.
28. Fawzy H, Osei-Tutu K, Errett L, et al. Sternal plate fixation for sternal wound reconstruction: initial experience (retrospective study). J Cardiothor.ac Surg. 2011; 6: 63. doi: 10.1186/1749-8090-6-63.
29. Tavlasoglu M, Kurkluoglu M, Arslan Z, et al. Detachment and dislocation of thermoreactive clips from sternum in late postoperative period due to misuse. Interact. Cardiovasc. Thorac. Surg. 2012; 14(4): 491-493. doi: 10.1093/icvts/ivr165.
30. Grapow MT, Melly LF, Eckstein FS, et al. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation. J Cardiothorac Surg. 2012; 7: 59. doi: 10.1186/1749-8090-7-59.
31. Melly L, Gahl B, Meinke R., et al. A new cable-tie-based sternal closure device: infectious considerations. Interact CardioVasc Thorac Surg. 2013; 17: 219-224. doi: 10.1093/icvts/ivt183.
32. Potapov VA, Kokhan EP, Asanov ON, et al. Use of vacuum therapy and bacteriophages in the complex treatment of deep sternal wound infection. Vestnik natsionalnogo mediko-khirurgicheskogo Tsentra im. N.I.Pirogova. 2021; 16(2): 66-71. (In Russ). doi: 10.25881/20728255_2021_16_2_66.
33. Shumacker HB, Mandelbaum JI. Continuous antibiotic irrigation in the treatment of infection. Arch. Surg. 1963; 86: 384-387.
34. Medvedchikov-Ardiya MA. Sovershenstvovaniye dvukhetapnoy khirurgicheskoy taktiki v lechenii patsiyentov s poststernotomnym mediastinitom. [dissertation] Samara; 2018. (In Russ). [URL]
35. Porkhanov VA, Kubyshkin VA, Parshin VD, et al. Klinicheskiye rekomendatsii po khirurgicheskomu lecheniyu bolnykh posleoperatsionnym mediastinitom i osteomiyelitom grudiny i reber. Krasnodar, Moscow, 2014. (In Russ).
36. Jurkiewicz MJ, Bostwick J, Hestler TR, et al. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann. Surg. 1980; 191(6): 738-743.
37. Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann. Surg. 1997; 225(6): 766-778.
38. Wettstein R, Erni D, Berdat P, et al. Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis. J. Thorac. Cardiovasc. Surg. 2002; 123(6): 1185-1190. doi: 10.1067/mtc.2002.121304.
39. Ascherman JA, Patel SM, Malhotra SM, et al. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg. 2004; 114: 676-683. doi: 10.1097/01.prs.0000130939.32238.3b.
40. Greig AV, Geh JL, Khanduja V, et al. Choice of flap for the management of deep sternal wound infection — an anatomical classification. J Plast Reconstr Aesthet Surg. 2007; 60: 372-378. doi: 10.1016/j.bjps.2006.10.005.
41. van Wingerden JJ, Lapid O, Boonstra PW, et al. Muscle flaps or omental flap in the management of deep sternal wound infection. Interact Cardiovasc Thorac Surg. 2011; 13: 179-187. doi: 10.1510/icvts.2011.270652.
42. Levy AS, Ascherman JA. Sternal Wound Reconstruction Made Simple. Plast Reconstr Surg Glob Open. 2019; 7(11): e2488. doi: 10.1097/GOX. 0000000000002488.
43. Mitish VA, Usu-Vuyyu OYU, Paskhalova YUS, et al. Experience in surgically treating chronic postoperative osteomyelitis of the sternum and ribs after minimally invasive myocardial revascularization. Wounds and wound infections. The Prof. BM Kostyuchenok journal. 2015; (2): 46-58. (In Russ). doi: 10.17 650/2408-9613-2015-2-2-46-55.
44. Kokhan EP, Aleksandrov AS. The diagnostics and treatment of the postoperative mediastinitis. Pirogov Russian Journal of Surgery. 2011; (9): 22-26. (In Russ).
45. Roh TS, Lee WJ, Lew DH, Tark KC. Pectoralis major-rectus abdominisbipedicled muscle flap in the treatment of poststernotomy mediastinitis. J Thorac Cardiovasc Surg. 2008; 136(3): 618-622. doi: 10.1016/j.jtcvs. 2008.01.044.
46. Nguyen DT, Aoki M, Hyakusoku H, Ogawa R. Chest wall reconstruction of severe mediastinitis with intercostal artery-based pedicled vertical rectus abdominis muscle flap with oblique-designed skin pedicle. Ann Plast Surg. 2011; 67(3): 269-271. doi: 10.1097/SAP.0b013e3181f77b8c.
47. Bakri K, Mardini S, Evans KK, et al. Workhorse flaps in chest wall reconstruction: the pectoralis major, latissimus dorsi, and rectus abdominis flaps. Semin Plast Surg. 2011; 25: 43-54. doi: 10.1055/s-0031-1275170.
48. Lee AB, Schimert G, Shaktin S, et al. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery. Surgery. 1976; 80(4): 433-436.
49. Dankov DV. Torakoomentoplastika v khirurgicheskom lechenii bolnykh s posleoperatsionnym sternomediastinitom. [dissertation] Moscow; 2017. (In Russ).
50. Izaddoost S, Withers EH. Sternal reconstruction with omental and pectoralis flaps: a review of 415 consecutive cases. Ann Plast Surg. 2012; 69: 296-300. doi: 10.1097/SAP.0b013e31822af843.
51. Jurkiewicz MJ, Arnold PG. The Omentum: An Account of its Use in the Reconstruction of the Chest Wall. Ann. Surg. 1977; 185(5): 584-54.
52. Korymasov EA, Pushkin SYU, Benyan AS, Medvedchikov-Ardiya MA. Post-sternotomy infectious complications: surgical treatment strategy and tactics. Wounds and wound infections. The Prof. BM Kostyuchenok journal. 2015; 2(4): 15-25. (In Russ). doi: 10.17650/2408-9613-2015-2-4-15-26.
53. Tassi V, Ceccarelli S, Vannucci J, et al. Mediastinitis and sternal prosthesis infection successfully treated by minimally invasive omental flap transposition. J. Cardiothorac. Surg. 2013; 8(1): 30. doi: 10.1186/1749-8090-8-30.
54. Dornseifer U, Kleeberger C, Ehrl D, et al. Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery J. Reconstr. Microsurg. 2016; 32(7): 506-512. doi: 10.1055/s-0036-1578815.
55. Pechetov AA, Yesakov YUS., Makov MA, et al. Laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection. Pirogov Russian Journal of Surgery. 2017; (8): 18-23. (In Russ. doi: 10.17116/hirurgia2017818-23.
56. Karian L, Granick M. Sternal wound reconstruction with omental flap for poststernotomy mediastinitis. Eplasty. 2013; 3(2): 33-37.
57. Elgharably H, Mann E, Awad H, et al. First evidence of sternal wound biofilm following cardiac surgery. PLoS One. 2013; 8: e70360. doi: 10.1371/ journal.pone.0070360.
