[Soft tissue emphysema in spontaneous pneumothorax. Features of medical approaches]. / Massivnaya emfizema myagkikh tkanei pri spontannom pnevmotorakse. Osobennosti lechebnoi taktiki.

Soft tissue emphysema (including subcutaneous emphysema) is common in pneumothorax. In most cases, this condition is of little clinical significance and regresses under standard medical procedures. However, progressive soft tissue emphysema poses a threat to the patient's life in case of compression of the upper respiratory tract in some cases. The world literature describes various approaches to the treatment of these patients. Standard medical care for progressive soft tissue emphysema following pneumothorax is pleural drainage with active aspiration. Despite unequivocal treatment tactics, this may not be enough in case of massive air release. Surgical treatment may be accompanied by surgical and anesthetic difficulties including difficult intubation. The authors present persistent tension pneumothorax and soft tissue emphysema, features of surgical and anesthetic management, as well as current treatment options.

[Chest wall morphological changes after sternal reconstruction with titanium mesh implant in patients with sternum instability]. / Strukturnye izmeneniya perednei grudnoi stenki posle alloplastiki grudiny titanovym setchatym endoprotezom u patsientov s nestabil'nost'yu grudiny.

Sternal instability is the one of the unresolved problems in open cardiac surgery (1-8%). The risk of recurrence after repeated osteosynthesis is up to 20% in these patients. Repeated osteosynthesis is impossible in some cases, and this complicates anterior chest wall reconstruction. Among various methods of sternal reconstruction, there are options for repair with own tissues and various fixing devices. Mesh prostheses from titanium and its alloys are modern materials for chest defect closure. There are literature data on soft tissue structural changes after hernia repair with titanium mesh implants, but biological compatibility and advantages of titanium alloys for chest wall instability are unclear. We present 2 patients after sternal reconstruction with titanium mesh implant and subsequent partial removal of prosthesis for various reasons with morphological examination.

[Additional vascularization of the omental flap using mammary-gastroepiploic bypass grafting in the treatment of deep sternal wound infection]. / Mammaro-gastroepiploichnoe shuntirovanie kak sposob dopolnitel'noi vaskulyarizatsii transplantata pri torakoomentoplastike u patsienta so sternomediastinitom.

Incidence of postoperative sternomediastinitis depends on various risk factors and makes up 8%. Surgical debridement with local management of the wound are used to achieve wound sterility. In some cases, sternectomy or subtotal sternal resection are performed for total sternal osteomyelitis with osteoporotic bone and multiple fractures. This procedure results an extensive bone defect. The final stage is anterior chest wall reconstruction. The most popular method is wound closure with autologous muscle or omental flaps. The authors describe a patient with sternomediastinitis who underwent staged treatment. At the final stage, subtotal sternectomy with simultaneous omentoplasty were performed. Additionally, mammary-gastroepiploic bypass grafting with right internal mammary artery and right gastroepiploic artery was carried out for additional vascularization of the omental flap. We found no similar surgery for sternomediastinitis in the literature. Long-term treatment outcome was followed-up (>50 months of relapse-free period and good quality of life).

[VATS resection of basal pyramid segments in sequestration of the left lower lobe]. / Videotorakoskopicheskaya rezektsiya segmentov bazal'noi piramidy pri sekvestratsii nizhnei doli levogo legkogo.

Lung sequestration is a congenital malformation represented by a non-functioning pulmonary parenchyma supplied via an aberrant artery of systemic circulation. This malformation makes up 1-6% of all congenital lung abnormalities. In 1946, Pryce M.D. proposed the term «lung sequestration¼ for the disease first described by the Austrian pathologist C. Rokitansky in 1856. Lung sequestration becomes quire common due to development and availability of X-ray diagnostic methods. An aberrant artery can arise from the great vessels (thoracic and abdominal aorta) and smaller arteries (coronary, intercostal arteries). To date, there are 2 forms of lung sequestration (intralobar and extralobar). We report one of the options for surgical treatment of lung sequestration.

[Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis]. / Kozhno-myshechnaya plastika v lechenii postluchevogo osteomielita kostei grudnoi kletki.

OBJECTIVE: To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC). MATERIAL AND METHODS: The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien-Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5-43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75-97.8). CONCLUSION: Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.

[Combined thoracoplasty using titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis]. / Kombinirovannaia torakoplastika setchatym titanovym éndoprotezom u patsientov s total'noi nestabil'nost'iu grudiny v iskhode khronicheskogo posleoperatsionnogo sternomediastinita.

OBJECTIVE: To analyze the results of chest wall reconstruction with titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis. MATERIAL AND METHODS: There were 100 patients with total sternal instability for the period from January 2016 to December 2018. Median of age was 62 (58; 68) years. Male/female ratio was 82/18. All patients were treated in accordance with standardized protocol. Postoperative complications were assessed using Clavien-Dindo scale. Staged surgical treatment including one or more debridement procedures before the final thoracoplasty was performed in 62 (62%) out of 100 patients. Aseptic sternal instability was observed in 38 patients. RESULTS: Follow-up period ranged from 3 weeks to 35 months after the final thoracoplasty. Complicated postoperative period occurred in 15 (15%) out of 100 patients (95% CI 9.3-23.3). One patient died in 9 days after surgery from acute heart failure. Complications without need for redo surgery, postoperative wound suppuration and seroma were noted in 3 patients. Redo surgery was required in 11 patients due to postoperative wound suppuration, eventration after thoracoomentoplasty, intermuscular hematoma and delayed divergence of major pectoral muscles. Removal of mesh implant was performed in 1 out of 100 patient (95% CI 0.2-5.5) in 7 days after surgery due to suppuration. There was no recurrent sternal instability within 30 days. CONCLUSION: Anterior chest wall reconstruction using titanium mesh implant is an effective and safe procedure in patients with postoperative sternal instability following postoperative sternomediastinitis.