First results of using a bidirectional U-shaped sternal suture in patients who have suffered a deep sternal infection

Abstract

Introduction. Sternomediastinitis in patients undergoing open heart operation remains a formidable complication. Treatment of a sternal infection is a complex and multi-component process. Closing of the sternal wound is one of the decisive steps in the treatment of sternomediastinitis. This is due to the fact that an insufficiently static state of the sternum in itself leads to a relapse of purulent-septic complications. At the same time, we have to work with non-native bone that has undergone inflammatory and destructive changes and multiple mechanical damage.The objective of the study was to evaluate the results of using the developed bidirectional U-shaped sternal suture for reosteosynthesis of the sternum in patients after postoperative mediastinitis.Methods and materials. The results of treatment of 16 patients with deep sternal infection in the early postoperative period were analyzed. All patients were divided into two groups according to the type of used sternal sutures. The first group consisted of 8 patients in whom a developed bidirectional U-shaped sternal suture was used for sternum reosteosynthesis. In the second group, in 8 patients, the sternal cusps were brought together using classic sternal figure-of-8 suture. A two-stage tactics of treatment was used both in the first and in the second groups of patients. Surgical debridement of the wound with removal of the primary sternal sutures was performed in the first stage. Subsequently, vacuum-assisted therapy was carried out using antiseptics. The second stage was the closure of the sternal wound after cleaning and decontamination of the wound.Results. Signs of sternal suture failure were not observed in the first group. Three patients underwent repeated plasty of the sternum due to the incompetence of the sternal sutures in the second group. One patient had relapse of wound infection.Conclusion. The developed bi-directional U-shaped sternal suture in patients after postoperative sternomediastinitis provides the prevention of inconsistency of sternum.