[Postoperative sternomediastinitis: morphology of lesion, treatment strategy]. / Posleoperatsionnyi sternomediastinit: morfologiya porazheniya, taktika lecheniya.

OBJECTIVE: To analyze bone tissue damage at different stages of disease (El Oakley classification), treatment options for each clinical situation and results after each approach. MATERIAL AND METHODS: There were 45 patients with wound complications after cardiac surgery between October 2022 and September 2023. Thirty-eight (84.4%) patients underwent CABG, 7 (15.6%) patients - heart valve or aortic surgery. Mean age of patients was 68.1±10.3 years. There were 35 men (77.8%) and 10 women (22.2%). The first type was found in 11 (24.5%) patients, type 2-3 - 19 (42.2%), type 4 - 4 (8.8%), type 5 - 11 (24.5%) patients. RESULTS: Systemic inflammatory response syndrome was observed in 7 (36.8%) persons of the 1st group, 14 (73.7%) ones of the 2nd group, 4 (100%) patients of the 3rd group and 2 (18.2%) patients of the 4th group. C-reactive protein and procalcitonin increased in all patients with the highest values in groups 2 and 3. Redo soft tissue inflammation occurred in all groups after treatment. Mean incidence was 25%. Two (10.5%) patients died in the 2nd group and 1 (25%) patient in the 3rd group. CONCLUSION: The modern classification of sternomediastinitis does not fully characterize severity of disease in a particular patient. Simultaneous debridement with wound closure demonstrates acceptable mortality (within 10%). The highest mortality rate was observed in patients with diffuse lesions of the sternum. Less aggressive treatment approaches are possible for stable anterior chest wall.

[Pathogenetic treatment of postoperative sternomediastinitis]. / Patogeneticheski obosnovannyi sposob lecheniya posleoperatsionnogo sternomediastinita.

Sternotomy is the most common surgical approach for cardiac surgery. Incidence of postoperative sternal diastasis and wound suppuration ranges from 0.11 to 10%. We present a variant of one-stage surgical treatment of patients with these postoperative complications. Surgical tactics and features of postoperative period are described in detail. Pathogenetic approach to the treatment is substantiated. This approach can be used in patients with aseptic diastasis of the sternum and sternomediastinitis.

[A new paradigm for the treatment of sternomediastinitis]. / Novaya paradigma lecheniya sternomediastinita.

OBJECTIVE: To analyze the results of simultaneous surgical treatment of sternomediastinitis compared to stage-by-stage approach. MATERIAL AND METHODS: The study included 27 patients between October 2022 and March 2023. All patients underwent heart surgery through median sternotomy. There were 11 (40.7%) women and 16 (59.3%) men. Mean age of patients was 68.4±9.8 years. All patients were divided into 2 groups: 12 patients underwent partial necrectomy and vacuum wound therapy (or long-term dressings) before surgery (group 1), 15 patients underwent surgery without prior conservative treatment (group 2). RESULTS: The most common causative agent of infection was staphylococcus (48.1%). In all patients, we found histological signs of osteomyelitis. Preoperative clinical status was similar in both groups. There were differences in the following indicators: C-reactive protein upon admission - 74.9±18.6 versus 94.8±23.8 mg/l, procalcitonin - 0.13 [0.02; 1.43] versus 0.21 [0.02; 0.94] ng/ml. Postoperative outcomes were similar in both groups. Mortality was 8.3% (n=1) and 13.3% (n=2), respectively. CONCLUSION: Simultaneous combined surgical treatment (sequestrectomy + muscle flap grafting) demonstrates optimal results in the treatment of sternomediastinitis.

[Tissue equivalent for the closure of extended urethral defects].

The aim of the present work was to develop a method for culturing epidermal keratinocytes to be used in a tissue equivalent for the closure of extended urethral defects. The experiment was carried out using 15 rabbits. Skin biopsies were obtained from the inner surface of the ear. The tissue equivalent consisted of collagen gel with embedded fibroblasts and epidermal keratinocytes grown on its surface; lavsan-mesh endoprosthesis served as the framework. Prefabrication of the neourethral plate was performed on the superficial fascia of m. rectus abdominis. The neourethral tube was formed after engraftment which was complete in all 15 animals. A histological study revealed morphological similarity of the neourethral tube thus engineered and the normal urethra.