Complex wound process in cardiac surgery. Tactics of anterior chest wall reconstruction

Abstract

Objective. The postoperative wound complications are an integral part of the treatment process in any surgical practice. The aim of this work is to optimize the tactics of management and the choice of a method for reconstructing the anterior chest wall of cardiosurgical patients with postoperative sternomediastinitis. Materials and methods. The development of sternomediastinitis in patients undergoing open heart surgery is the highest risk factor for life. According to many authors, it occurs in 0.511 % of patients, while the fatality of this complication can reach up to 4050 %. This condition develops in a number of patients in a cardiac surgery hospital who have certain developmental predictors. Results. Thus, in our work, we consider preoperative, intraoperative and postoperative risk factors for the development of sternomediastinitis. Based on all the data studied in the world literature and our own experience, we algorithmized the approach to choosing the tactics of anterior chest wall reconstruction, determined the time frame and gave specific recommendations based on clinical examples, which confirms the practical effectiveness of the proposed methods. Conclusions. A differentiated approach to the choice of the method of plastic intervention is given, the tactical priority of using muscle flaps or segmental resection of the sternum is substantiated, and the importance of omentoplasty of a chest defect in severe purulent-septic lesions of a large scale is also updated.