ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.25789/YMJ.2021.73.29ymj-523Research ArticleНАУЧНЫЕ ОБЗОРЫ И ЛЕКЦИИSCIENTIFIC REVIEWS AND LECTURESХирургическое лечение послеоперационного стерномедиастинитаSurgical treatment of postoperative sternomediastinitishttps://orcid.org/0000-0003-3096-038XШевченкоА. А.ShevchenkoA. A.

Шевченко Александр Александрович – к.м.н., доцент;

врач хирург высшей квалиф. категории ОТХ

Shevchenko Alexandr Alexandrovich - candidate of medical Sciences, associate Professor of the Department

phone 8-914-770-34-77

aleshev2@yandex.ruhttps://orcid.org/0000-0001-8427-7346ЖилаН. Г.ZhilaN. G.

Жила Николай Григорьевич – д.м.н., проф.

Zhila Nikolai Grigorievich: doctor of medical Sciences, Professor of department of surgical diseases of childhood

nzhila@list.ruБояринцевН. И.BoyarintsevN. I.

Бояринцев Николай Иванович – д.м.н., проф., и.о. зав. Кафедрой

Boyarintsev Nikolay Ivanovich - doctor of medical sciences, professor, Deputy Head of the Department of Oncology, Surgery and Endoscopy

8-924-156-45-54

nib777@yandex.ruДальневосточный ГМУ; Краевая клинич. б-ца №1 МЗ Хабаровского краяРоссияSurgery FESMURussian FederationСанкт-Петербургский ГПМУ МЗ РоссииРоссияSaint Petersburg state pediatric medical UniversityRussian FederationДГМУРоссияFar Eastern State Medical UniversityRussian Federation20212704202501111115Copyright © Шевченко А.А., Жила Н.Г., Бояринцев Н.И., 20252025Шевченко А.А., Жила Н.Г., Бояринцев Н.И.Shevchenko A.A., Zhila N.G., Boyarintsev N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/523

Изучены данные литературы на предмет исторических этапов становления лечения послеоперационных стерномедиастинитов. На начальных этапах хирургами осуществлялось открытое лечение раны грудной клетки, затем проводилось лечение методом проточнопромывной системы, при этом обе методики сопровождались высокой частотой осложнений и летальности. В последующем специалисты стали активно применять хирургический метод лечения в сочетании с объемными реконструктивными операциями по мере очищения раны, что способствовало снижению частоты смертности (с 50 до 5,1%) от таких грозных осложнений кардиохирургических операций, как послеоперационные стерномедиастиниты. Однако вероятность осложнения трансстернального доступа и рецидива инфекции сохраняется независимо от проводимых мер профилактики при выполнении кардиохирургической операции, что указывает на целесообразность активной разработки в настоящее время инновационных подходов к комплексному лечению рассматриваемой патологии.

The literature data on the historical stages of the treatment of postoperative sternomediastinitis were studied. At the initial stages, surgeons carried out open treatment of chest wounds, then treated with the flow-lavage system, with both methods accompanied by a high incidence of complications and mortality. Subsequently, specialists began to use actively the surgical method of treatment in combination with volumetric reconstructive operations as the wound was cleared, which contributed to a decrease in the mortality rate (from 50 to 5.1%) from such formidable complications of cardiac surgery as postoperative sternomediastinitis. However, the likelihood of complications of trans-sternal access and recurrence of infection persists regardless of the preventive measures taken during cardiac surgery, which indicates the expediency of active development of innovative approaches to the complex treatment of the pathology under consideration.

торакальная хирургияпослеоперационный стерномедиастинитгнойные осложнения кардиохирургических операцийthoracic surgerypostoperative sternomediastinitispurulent complications of cardiac surgeryReferencesБельских В.М. К вопросу о реконструктивно-востановительном этапе лечения у больных послеоперационными стерномедиастинитами. / Бельских В.М., Самодай В.Г., Солод Н.В., Юргелас И.В. // Вестник новых медицинских технологий. - 2005;XII:3-4:150Belskih V.M. On the question of the reconstructive-restorative stage of treatment in patients with postoperative sternomediastinitis. / Belskih V.M., Samodaj V.G., Solod N.V., Jurgelas I.V. // Bulletin of contemporary medical technologies. - 2005; XII:3-4:150.Головтеев В.В. Лечение инфекционных поражений грудной клетки/ Головтеев В.В., Вишневская Г.А., Вишневский А.А. //Анналы пластической, реконструктивной и эстетической хирургии. - 2002;4:41 – 42.Golovteev V.V. Treatment of chest infections / Golovteev V.V., Vishnevskaja G.A., Vishnevskij A.A. // Annals of plastic, reconstructive and aesthetic surgery. - 2002;4:41 – 42.Косенков А.В. Стерномедиастинит после кардиохирургических вмешательств/ Косенков А.В., Винокуров И.А., Аль-Юсеф А.Н. // Медико-социальная экспертиза и реабилитация. - 2020;23:1:18-23. Doi: 10.17816/MSER34526Kosenkov A.V. Sternomediastinitis after cardiac surgery / Kosenkov A.V., Vinokurov I.A., Al'-Jusef A.N. // Medical and social expertise and rehabilitation. - 2020;23:1:18-23 (In Russ.). Doi: 10.17816/MSER34526Кохан Е.П. Послеоперационные медиастиниты. Диагностика и лечение / Кохан Е.П., Александров А.С.// Хирургия. - 2011; 9:22–26.Kohan E.P. Postoperative mediastinitis. Diagnostics and treatment / Kohan E.P., Aleksandrov A.S. // Surgery. - 2011; 9:22–26. (In Russ.).Лапароскопически-ассистированная торакооментопластика и реконструкция обширных дефектов передней грудной стенки. / Печетов А.А., Есаков Ю.С., Маков М.А. [и др.] // Хирургия. - 2017;8:18 – 23Laparoscopically-assisted thoracoomentoplasty and reconstruction of extensive defects of the anterior chest wall. / Pechetov A.A., Esakov Ju.S., Makov M.A. [et al.] // Surgery. -. 2017;8:18 – 23.Клинические рекомендации по хирургическому лечению больных послеоперационным медиастинитом и остеомиелитом грудины и ребер / Порханов В.А., Печетов А.А., Митиш В.А. [и др.]. - Краснодар: Москва, 2014:25.Clinical guidelines for surgical treatment of patients with postoperative mediastinitis and osteomyelitis of the sternum and ribs. / Porhanov V.A., Pechetov A.A., Mitish V.A. [et al.]. - Krasnodar: Moskva, 2014:25.Потемкин А.В. Особенности комплексной диагностики и хирургической тактики в лечении послеоперационного стерномедиастинита /Потемкин А.В., Цейликман В.Э., Синицкий А.И. //Гений ортопедии. - 2011;4:67–70Potemkin A.V. Features of complex diagnostics and surgical tactics in the treatment of postoperative sternomediastinitis / Potemkin A.V., Ceylikman V.E., Sinitsky A.I. // Orthopedic genius. - 2011;4:67–70.Стратегия и тактика хирургического лечения инфекционных осложнений после стернотомии. / Корымасов Е.А, Пушкин С.Ю., Бенян А.С. [и др.] // Раны и раневые инфекции. - 2015;2(4):15-25.Strategy and tactics of surgical treatment of infectious complications after sternotomy/ Korimasov EA, Pushkin CU, Benyan AS. [et al.] // Injuries and wound. - 2015; 2(4):15-25.Тактика ведения постстернотомного медиастинита у кардиохирургических пациентов / Горбунов В.А., Джорджикия Р.К., Мухарямов М.Н. [и др.] // Хирургия. - 2016;11:2:41–45.Management tactics of post-sternotomy mediastinitis in cardiac surgery patients. / Gorbunov V.A., Georgikia R.K., Mukharyamov M.N. [et al.] // Surgery .- 2016;11:2:41–45.Хирургическое лечение послеоперационного гнойного стерномедиастинита. / Белов Ю.В., Комаров Р.Н., Чернявский С.В. [и др.] // Хирургия. - 2015;7:85 – 87Surgical treatment of postoperative purulent sternomediastinitis / Belov Ju.V., Komarov R.N., Chernyavskiy S.V. [et al.] // Surgery. - 2015;7:85 – 87.Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles. / Cartier R, Brunette I, Hashimoto K. [et al] //J Thorac Cardiovasc Surg. -1990; 99:2:264-268.Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles. / Cartier R, Brunette I, Hashimoto K. [et al] //J Thorac Cardiovasc Surg. -1990; 99:2:264-268.Argenta LC., Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience // Ann Plast. Surg. 1997; 38:6:563–577.Argenta LC., Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience // Ann Plast. Surg. 1997; 38:6:563–577.Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery. / Dornseifer U, Kleeberger C, Ehrl D. [et al] // J Reconstr Microsurg. 2016; 32:7:506-512. Doi: 10.1055/s-0036-1578815.Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery. / Dornseifer U, Kleeberger C, Ehrl D. [et al] // J Reconstr Microsurg. 2016; 32:7:506-512. Doi: 10.1055/s-0036-1578815.Brown RG, Fleming WH, Jurkiewicz MJ. An island flap of the pectoralis major muscle// Br J Plast Surg. 1977; 30:2:161-165.Brown RG, Fleming WH, Jurkiewicz MJ. An island flap of the pectoralis major muscle// Br J Plast Surg. 1977; 30:2:161-165.Cost-Effectiveness of Negative Pressure Incision Management System in Cardiac Surgery. /Hawkins RB, Mehaffey JH, Charles EJ. [et al.] // J Surg Res. 2019; 240:227-235. Doi: 10.1016/j.jss.2019.02.046.Cost-Effectiveness of Negative Pressure Incision Management System in Cardiac Surgery. /Hawkins RB, Mehaffey JH, Charles EJ. [et al.] // J Surg Res. 2019; 240:227-235. Doi: 10.1016/j.jss.2019.02.046.Does method of sternal repair influence long-term outcome of postoperative mediastinitis? / Atkins BZ, Onaitis MW, Hutcheson KA. [et al.] // Am J Surg. 2011; 202:5:565-7. Doi: 10.1016/j.amjsurg.2011.06.013.Does method of sternal repair influence long-term outcome of postoperative mediastinitis? / Atkins BZ, Onaitis MW, Hutcheson KA. [et al.] // Am J Surg. 2011; 202:5:565-7. Doi: 10.1016/j.amjsurg.2011.06.013.Juhl AA, Koudahl V, Damsgaard TE. Deep sternal wound infection after open heart surgery--reconstructive options // Scand Cardiovasc J. 2012; 46:5:254-61. Doi: 10.3109/14017431.2012.674549.Juhl AA, Koudahl V, Damsgaard TE. Deep sternal wound infection after open heart surgery--reconstructive options // Scand Cardiovasc J. 2012; 46:5:254-61. Doi: 10.3109/14017431.2012.674549.Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. //J Cardiothorac Surg. 2017 ;2:12:1:94. Doi: 10.1186/s13019-017-0656-7.Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. //J Cardiothorac Surg. 2017 ;2:12:1:94. Doi: 10.1186/s13019-017-0656-7.Krabatsch T, Hetzer R. Poststernotomy mediastinitis treated by transposition of the greater omentum.// J Card Surg. 1995; 10:6:637-43.Krabatsch T, Hetzer R. Poststernotomy mediastinitis treated by transposition of the greater omentum.// J Card Surg. 1995; 10:6:637-43.Long-term result of bilateral pectoralis major muscle advancement flap in median sternotomy wound infections. // Carlesimo B, Lo Torto F, Rossi A. [et al.] // Eur Rev Med Pharmacol Sci. 2014;18:24:3767-72.Long-term result of bilateral pectoralis major muscle advancement flap in median sternotomy wound infections. // Carlesimo B, Lo Torto F, Rossi A. [et al.] // Eur Rev Med Pharmacol Sci. 2014;18:24:3767-72.Long-term results of flap reconstruction in median sternotomy wound infections. / Ringelman PR, Vander Kolk CA, Cameron D [et al.] // Plast Reconstr Surg. 1994; 93:6:1208-14; discussion 1215-6.Long-term results of flap reconstruction in median sternotomy wound infections. / Ringelman PR, Vander Kolk CA, Cameron D [et al.] // Plast Reconstr Surg. 1994; 93:6:1208-14; discussion 1215-6.Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. / Jones G, Jurkiewicz MJ, Bostwick J, [et al.] //Ann Surg. 1997 Jun;225(6):766-776; discussion 776-778.Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. / Jones G, Jurkiewicz MJ, Bostwick J, [et al.] //Ann Surg. 1997 Jun;225(6):766-776; discussion 776-778.Martin RD The management of infected median sternotomy wounds// Ann Plast Surg. 1989; 22:3:243-51.Martin RD The management of infected median sternotomy wounds// Ann Plast Surg. 1989; 22:3:243-51.Muscle flaps or omental flap in the management of deep sternal wound infection. / Van Wingerden JJ, Lapid O, Boonstra PW [et al.] // Interact Cardiovasc Thorac Surg. 2011; 13:2:179-187. Doi: 10.1510/icvts.2011.270652Muscle flaps or omental flap in the management of deep sternal wound infection. / Van Wingerden JJ, Lapid O, Boonstra PW [et al.] // Interact Cardiovasc Thorac Surg. 2011; 13:2:179-187. Doi: 10.1510/icvts.2011.270652Pairolero PC, Arnold PG, Harris JB. Longterm results of pectoralis major muscle transposition for infected sternotomy wounds // Ann Surg. 1991; 213:6:583-9; discussion 589-90.Pairolero PC, Arnold PG, Harris JB. Longterm results of pectoralis major muscle transposition for infected sternotomy wounds // Ann Surg. 1991; 213:6:583-9; discussion 589-90.Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis. / Wettstein R, Erni D, Berdat P [et al.] //J Thorac Cardiovasc Surg. 2002; 123:6:1185-90.Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis. / Wettstein R, Erni D, Berdat P [et al.] //J Thorac Cardiovasc Surg. 2002; 123:6:1185-90.Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method. / Kalab M, Karkoska J, Kaminek M [et al.] // Interact CardioVasc Thorac Surg 2016; 22:305–13.Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method. / Kalab M, Karkoska J, Kaminek M [et al.] // Interact CardioVasc Thorac Surg 2016; 22:305–13.Rigid internal fixation of the sternum in postoperative mediastinitis. / Gottlieb LJ, Pielet RW, Karp RB.[ et al.] // Arch Surg. 199; 129:5:489-93.Rigid internal fixation of the sternum in postoperative mediastinitis. / Gottlieb LJ, Pielet RW, Karp RB.[ et al.] // Arch Surg. 199; 129:5:489-93.Saltz R. Endoscopic harvest of the omental and jejunal free flaps.// Clin Plast Surg. 1995; 22:4:747-54.Saltz R. Endoscopic harvest of the omental and jejunal free flaps.// Clin Plast Surg. 1995; 22:4:747-54.The fate of patients having deep sternal infection after bilateral internal thoracic artery grafting in the negative pressure wound therapy era. / Gatti G, Benussi B, Brunetti D. [et al] // Int J Cardiol. 2018; 15:269:67-74. Doi: 10.1016/j.ijcard.2018.07.090.The fate of patients having deep sternal infection after bilateral internal thoracic artery grafting in the negative pressure wound therapy era. / Gatti G, Benussi B, Brunetti D. [et al] // Int J Cardiol. 2018; 15:269:67-74. Doi: 10.1016/j.ijcard.2018.07.090.The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery. / Julian OC, Lopez-Belio M, Dye WS, [et al.] // Surgery. 1957; 42:753–761.The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery. / Julian OC, Lopez-Belio M, Dye WS, [et al.] // Surgery. 1957; 42:753–761.Therapy options in deep sternal wound infection: Sternal plating versus muscle flap. / Grapow M, Haug M, Tschung C. [et al.]// PLoS One. 2017; 30:12:6:e0180024. Doi: 10.1371/journal.pone.0180024.Therapy options in deep sternal wound infection: Sternal plating versus muscle flap. / Grapow M, Haug M, Tschung C. [et al.]// PLoS One. 2017; 30:12:6:e0180024. Doi: 10.1371/journal.pone.0180024.Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful stratagems in managing severe mediastinal infection following open heart surgery. / Lee AB, Jr, Schimert G, Shaktin S, Seigel JH. // Surgery. 1976; 80:4:433–436.Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful stratagems in managing severe mediastinal infection following open heart surgery. / Lee AB, Jr, Schimert G, Shaktin S, Seigel JH. // Surgery. 1976; 80:4:433–436.Verkkala K, Järvinen A. Mediastinal infection following open-heart surgery. Treatment with retrosternal irrigation.// Scand J Thorac Cardiovasc Surg. 1986; 20:3:203-7.Verkkala K, Järvinen A. Mediastinal infection following open-heart surgery. Treatment with retrosternal irrigation.// Scand J Thorac Cardiovasc Surg. 1986; 20:3:203-7.Weinzweig N, Yetman R. Transposition of the greater omentum for recalcitrant median sternotomy wound infections.// Ann Plast Surg. 1995; 34:5:471-477.Weinzweig N, Yetman R. Transposition of the greater omentum for recalcitrant median sternotomy wound infections.// Ann Plast Surg. 1995; 34:5:471-477.

The authors declare that there are no conflicts of interest present.