A comprehensive surgical approach to the treatment of deep sternal wound infection after heart transplantation
https://doi.org/10.15825/1995-1191-2021-2-67-75
Abstract
Deep wound infection of the anterior chest wall tissues in patients after transsternal cardiac surgery despite intensive developments in surgical techniques and improvement of antibacterial chemotherapy, remains a genuine concern worldwide [1]. The incidence of this complication in the general population ranges from 0.5 to 4% [2, 3]. Despite developed approaches in the treatment of cardiac surgery patients, the treatment of deep sternal wound infection and surrounding tissues following a heart transplantation still remains a rather serious and pressing challenge. This paper presents a clinical observation of a heart transplant recipient, complicated by deep postoperative wound infection. The strategy of staged surgical treatment of sternal osteomyelitis consisted of surgical wound debridement, local wound debridement with vacuum dressings, and reconstructive surgery at the final stage (sternal reosteosynthesis, plasty of the anterior chest wall wound with displaced skin and fascial flaps).
About the Authors
V. M. ZakharevichRussian Federation
Moscow
V. A. Mitish
Russian Federation
Moscow
T. A. Khalilulin
Russian Federation
Moscow
A. R. Zakiryanov
Russian Federation
Moscow
D. S. Ivanov
Russian Federation
Denis S. Ivanov
1, Shchukinskaya str., Moscow, 123182
A. M. Goltz
Russian Federation
Moscow
A. A. Sukhatchev
Russian Federation
Moscow
K. S. Kiryakov
Russian Federation
Moscow
O. A. Pozdnyakov
Russian Federation
Moscow
N. Y. Zacharevich
Russian Federation
Moscow
References
1. Vestergaard RF. Effect of Hemostatic Material on Sternal Healing After Cardiac Surgery. The Annals of thoracic surgery. 2014; 97 (1): 153–160.
2. Rehman SM. Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity. Journal of Hospital Infection. 2014; 88 (2): 96–102.
3. Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg. 2010; 89: 1502–1509.
4. Tang GHL, Maganti M, Weisel RD, Borger MA. Prevention and management of deep sternal wound infection. Semin Thorac Cardiovasc Surg. 2004; 16: 62–69.
5. Sa MP, Soares EF, Santos CA. Risk factors for mediastinitis after coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc. 2011; 26: 27–35.
6. Diez C, Koch D, Kuss O. Risk factors for mediastinitis after cardiac surgery – a retrospective analysis of 1700 patients. J Cardiothorac Surg. 2007; 2: 23.
7. Ye X. Incidence and costs of bleeding-related complications in French hospitals following surgery for various diagnoses. BMC health services research. 2013; 13 (1): 186.
8. Ariyaratnam P, Bland M, Loubani M. Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population: a basis for a new risk model? Interact Cardiovasc Thorac Surg. 2010; 11: 543–546.
9. Kunal S. Mediastinitis in cardiac surgery: A review of the literature. International Journal of Medicine and Biomedical Research. 2013; 1 (2): 97–103.
10. Gautier SV, Khomyakov SM. Donorstvo i transplantatsiya organov v Rossiyskoy Federatsii v 2015 godu. VIII soobshchenie registra Rossiyskogo transplantologicheskogo obshchestva. Transplantologiya: itogi i perspektivy. Tom VII. 2015 god / Pod red. S.V. Gautier. M.–Tver’: Triada, 2016. 448.
11. Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg. 2004; 77 (2): 676–683.
12. Ku CH, Ku SL, Yin JC. Risk factors for sternal and leg surgical site infections after cardiac surgery in Taiwan. Am J Epidemiol. 2005; 161: 661–671.
13. Mitish VA, Zakharevich VM, Merzlyakov VYu, Popov VA, Skopin AI. Aktivnoe khirurgicheskoe lechenie posleoperatsionnogo osteomielita grudiny i reber posle koronarnykh i kardiokhirurgicheskikh operatsiy. Byulleten’ NTsSSKh A.N. Bakuleva RAMN. Serdechno-sosudistye zabolevaniya. 2005; 6 (S5): 77.
14. Mitish VA, UsuVuyyu OYu, Paskhalova YuS, Ushakov AA, Zvyagin AA, Orudzheva SA, Zhestkov MS. Opyt khirurgicheskogo lecheniya khronicheskogo posleoperatsionnogo osteomielita grudiny i reber posle mini-invazivnoy revaskulyarizatsii miokarda. Rany i ranevye infektsii. 2015; 2 (2): 46–57.
15. Mitish VA, Usu-Vuyyu OYu, Paskhalova YuS, Ushakov AA, Magomedova SD, Baltun LA i dr. Opyt khirurgicheskogo lecheniya patsientov vysokogo riska vsledstvie khronicheskogo posleoperatsionnogo osteomielita grudiny i reber. Rany i ranevye infektsii. 2017; 4 (3): 14–22.
Review
For citations:
Zakharevich V.M., Mitish V.A., Khalilulin T.A., Zakiryanov A.R., Ivanov D.S., Goltz A.M., Sukhatchev A.A., Kiryakov K.S., Pozdnyakov O.A., Zacharevich N.Y. A comprehensive surgical approach to the treatment of deep sternal wound infection after heart transplantation. Russian Journal of Transplantology and Artificial Organs. 2021;23(2):67-75. https://doi.org/10.15825/1995-1191-2021-2-67-75