Development of the concept of complex treatment postoperative sternomediastinitis
https://doi.org/10.30629/0023-2149-2022-100-9-10-439-446
Abstract
The review describes the evolution of surgical and medical methods of treatment regarding a new nosological formpostoperative sternomediastinitis, which develops against the background of cardiac surgery tremendous upgrowth. The effectiveness of integration a surgical approach with the combined use of vacuum therapy and bacteriophages in the cleansing of the poststernotomy wound, as well as antibiotics and bacteriophages combination in order to control antibiotic-resistant pathogenic flora of the purulent-septic process in the anterior mediastinum, has been shown. Our own material included the treatment of 88 patients with deep sternal infection. The method proposed by the authors made it possible to reduce the duration of treatment and hospital mortality to 5%.
Keywords
postoperative sternomediastinitis,
deep sternal infection,
surgical treatment,
vacuum therapy,
bacteriophages,
biofilms
Supporting agencies: The study had no sponsorship
About the Authors
P. G. Bryusov
Branch of the S.M. Kirov Military Medical Academy in Moscow; The Main Military Clinical Hospital named after Аcademician N.N. Burdenko of the Ministry of Defense of Russia
Russian Federation
Russian Federation
Bryusov Pavel G.
107392, 105094, Moscow
A. N. Lishchuk
National Medical Research Center of High Medical Technologies — A.A. Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of Russia
Russian Federation
Russian Federation
Lischuk Akeksandr N.
143420, Krasnogorsk
V. A. Potapov
Branch of the S.M. Kirov Military Medical Academy in Moscow
Russian Federation
Russian Federation
Potapov Vyuacheslav A.
107392, Moscow
References
1. Belov Y.V. Guide to Vascular Surgery with Atlas of Operative Techniques. Moscow: Medical information agency. 2011. (In Russian).
2. Vishnevskij A.A., Rudakov S.S., Milanov N.O. Chest Wall Surgery. Moscow: Vidar. 2005. (In Russian).
3. El Oakley R.M., Wright J. Post-operative mediastinitis: classifi cation and management. Ann. Thorac. Surg. 1996;61:1030–6. DOI: 10.1016/0003-4975(95)01035-1
4. Khubulava G.G., Shikhverdiyev N.N., Fogg P.R., et al. Predicting the probability of the sternal wound infection in patients undergoing cardiac surgery. Grekov’s Bulletin of Surgery. 2018;177(1):11–15. (In Russian). DOI: 10.24884/0042-4625-2018-177-1-11-15
5. Porkhanov V.A., Kubyshkin V.A., Parshin V.D. et al. Cli nical recommendations for surgical treatment of patients with postoperative mediastinitis and osteomyelitis of the sternum and ribs. Krasnodar, Moscow, 2014:26. (In Russian). [Electronic resource] URL: https://www.mzur.ru›upload/iblock/a43/Sternomediastinit.docx
6. Morgante A., Romeo F. Deep sternal wound infections: a severe complication after cardiac surgery. G. Chir. 2017;38(1):33–36. DOI: 10.11138/gchir/2017.38.1.033
7. Bonacchi M., Prifti E., Bugetti M. et al. Deep sternal infections after in situ bilateral internal thoracic artery grafting for left ventricular myocardial revascularization: predictors and infl uence on 20-year outcomes. J. Thorac. Dis. 2018;10(9):5208–5221. DOI: 10.21037/jtd.2018.09.30
8. Pinto A.M., Cerqueira M.A., Banobre-Lopes M. et al. Bacteriophages for chronic wound treatment: from traditional to novel delivery systems. Viruses. 2020;12(2):235. DOI: 10.3390/v12020235. [Electronic resource]. URL: https://www.mdpi.com/journal/viruses
9. Sarr M.G., Gott V.L., Townsend T.R. Mediastinal infection after cardiac surgery. Ann. Thorac. Surg.1984;38(4):415–423. DOI: 10.1016/s0003-4975(10)62300-4
10. Shumacker H.B., Mandelbaum Jr. I. Continuous antibiotic irrigation in the treatment of infection. Arch. Surg. 1963;86:384–387. DOI: 10.1001/archsurg.1963.01310090034006
11. Slesarenko S.S., Agapov V.V., Prelatov V.A. Mediastinitis. Moscow: Medical practice, 2005:200. (In Russian).
12. Vos R.J., Van Putte B.P., Sonker U. et al. Primary closure using Redon drains for the treatment of post-sternotomy mediastinitis. Interact. Cardiovasc. Thorac. Surg. 2014;18(1):33–37. DOI: 10.1093/icvts/ivt385
13. Kanshin N.N., Maksimov Yu.M., Valenko A.V. Constant aspiration in the prevention of suppuration of postoperative wounds. Bulletin of Surgery. 1983;7:15–18. (In Russian).
14. Cohen M., Yaniv Y., Weiss J. et al. Median sternotomy wound complication: the effect of reconstruction on lung function. Ann. Plast. Surg. 1997;39(1):36–43. DOI: 10.1097/00000637-199707000-00006
15. Song D.H., Lohman R.F., Renucci J.D. et al. Primary sternal plating in high-risk patients mediastinitis. Eur. J. Cardiothorac. Surg. 2004;26(2):67–72. DOI: 10.1016/j.ejcts.2004.04.038
16. Apelqvist J., Willy C., Fagerdahl A.M. et al. Negative pressure wound therapy – overview, challenges and perspectives. J. Wound Care. 2017;26:3, Suppl. 3,S1–S113. DOI: 10.12968/jowc.2017.26.Sup3.S1
17. Mitish V.A., Usu-Vuyyu O.Yu., Paskhalova YU.S. et al. Experience in surgically treating chronic postoperative osteomyelitis of the sternum and ribs after minimally invasive myocardial revascularization. Wounds and wound infections. The Prof. B.M. Kostyuchenok journal. 2015;(2):46–58. (In Russ). DOI: 10.17650/2408-9613-2015-2-2-46-55
18. Shikhverdiyev N.N., Khubulava G.G., Marchenko S.P., Suvorov V.V. Intraoperative local administration of antibiotics for prevention of sternal wound infection in cardiac surgery. Circulation pathology and cardiac surgery. 2017;21(1):69-72. (In Russian).
19. Furgal A.A., Muratov R.M., Shchava S.P. et al. Comparative evaluation of the continuous and intermittent modes of vacuum therapy for the management of deep sternal wound infection after cardiac surgery. Clinical and experimental surgery. The journal named after Academician B.V. Petrovsky. 2019;7(2):71–78. (In Russian). DOI: 10.24411/2308-1198-2019-12010
20. Potapov V.A., Kokhan E.P., Asanov O.N. et al. Use of vacuum ther apy and bacteriophages in the complex treatment of deep sternal wound infection. Bulletin of Pirogov national medical and surgical center. 2021;16(2):66–71. (In Russ). DOI: 10.25881/20728255_2021_16_2_66
21. Goryunov S.V., Abramov I.S., C hapar’yan B.A. et al. Guidelines for the treatment of wounds by controlled negative pressure. Moscow: April. 2013. (In Russian).
22. Lednev P.V., Belov Y.V., Stonogin A.V. et al. Postoperative sternomediastinitis. Pirogov Russian Journal of Surgery. 2018;(4):84–89. (In Russian). DOI: 10.17116/hirurgia2018484-89
23. Steingrimsson S., Gottfredsson M., Gudmundsdottir I. et al. Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections. Interact. Cardiovasc. Thorac. Surg. 2012;15(3):406–410. DOI: 10.1093/icvts/ivs254
24. Van Wingerden J.J., Ubbink D.T., Van der Horst C.M., De Mol B.A. Poststernotomy mediastinitis: a classifi cation to initiate and evaluate reconstructive management based on evidence from a structured review. J. Cardiothorac. Surg. 2014;23(9):79–184. DOI: 10.1186/s13019-014-0179-4
25. Morykwas, M.J., Argenta L.C., Shelton-Brown E.I. et al. Vacuumassisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann. Plast. Surg.1997;38(6):553–562. DOI: 10.1097/00000637-199706000-00001
26. Davydov Yu.A., Larichev A.B. Vacuum therapy of wounds and wound process. Moscow: Medicine, 1999. (In Russian).
27. Obolenskiy V.N., Se menistyy A.Yu., Nikitin V.G. et al. Vacuum therapy in the treatment of wounds and wound infection. Russian Medical Journal. 2010;18(17):1064–1072. (In Russian).
28. Vacuum assisted closure: recommendations for use. A consensus document. World Union of Wound Healing Societies’ Initiative, Expert Working Group. Int. Wound J. 2008;5(s4):19–29. DOI: 10.1111/j.1742-481X.2008.00537.х
29. Vishnevskiy A.A., Pechetov A.A. Modern multistage surgical treatment of patients with chronic postoperative sternomediastinitis. Practical medicine. 2010;8(47):63–65. (In Russian).
30. Belov Yu.V., Komarov R.N., Chernyavskiy S.V. Surgical treatment of postoperative suppurative sternomediastinitis. Pirogov Russian Journal of Surgery. 2013;(3):11–16. (In Russian).
31. Gaudreau G., Costache V., Houde C. et al. Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation. Eur. J. Cardiothorac. Surg. 2010;37:888–892. DOI: 10.1016/j.ejcts.2009.07.043
32. Moues C.M., Heule F., Hovius S.E. A review of topical negative pressure therapy in wound healing: sufficient evidence? Am. J. Surg. 2011;201:544–556. DOI: 10.1016/j.amjsurg.2010.04.029
33. Beloborodov, V.B., Gusa rov V.G., Dekhnich A.V. et al. Diagnostics and antimicrobial therapy of infections caused by polyresistant microorganisms. Messenger of Anesthesiology and Resuscitation. 2020;17(1):52–83. (In Russian).
34. Shlyapnikov S.A., Naser N.R., Batyrshin I.M. et al. The antibiotic-associated colitis is a new problem in surgery. Bulletin of Pirogov national medical and surgical center. 2020;15(2):138–143. (In Russ.). DOI: 10.25881/BPNMSC.2020.62.96.024
35. Obolenskij V.N., Zolotarjov D.V. Methods of prolonged local antibacterial therapy and local negative pressure in the treatment of infectious wound complications of sternotomy: an analytical review, clinical examples. Сlinical and experimental surgery. Petrovsky journal. 2016; 4(2):71–79. (In Russian).
36. Yusuf E., Chan M., Renz N. et al. Current perspectives on diagnosis and management of sternal wound infections. Infect. Drug. Resist. 2018;(1):961–968. doi: 10.2147/IDR.S130172.
37. Pokrovskaya M.P., Kaganova L.S., Morozenko M.A. et al. Treatment of wounds with bacteriophage. Narkomzdrav SSSR. Moscow: Medgiz, 1941. (In Russian).
38. Il′ina T.S., Tolordava E.R., Romanova Yu.M. Looking at phage therapy 100 years after the discovery of bacteriophages. Molecular Genetics, Microbiology and Virology. 2019;37(3):103–112. (In Russian). DOI: org/10.17116/molgen201937031103
39. Salmina T.A., Tsygipalo A.I., Shkoda A.S. The experience of use of pyobacteriophage polyvalent purifi ed for the treatment of purulent wounds with prolonged and ineffective treatment with antibacterial drugs. Difficult patient. 2016;10–11:5–11. (In Russian).
40. Brjusov P.G., Zubrickij V.F., Islamov R.N. et al. The phage-prevention and phagotherapy surgical infections. Medical Bulletin of the Ministry of Internal Affairs. 2017;87(2):9–13. (In Russian).
41. Chan K., Abedon S.T., Los-Carillo C. Phage cocktails and the future of phage therapy. Future Microbiol. 2013;8(6):769–783. DOI: 10.2217/fmb.13.47
42. Al-Wrafy F., Brzozouska E., Gorska S., Gamian A. Pathogenic factors of Pseudomonas aeruginosa — the role of biofilm in pathoge necity and as a target for phage therapy. Postepy Hig. Med. Dosw. 2016;70:78–91. DOI: 10.5604/01.3001.0010.3792
43. Kutateladze M., Adamia R. Bacteriophages as potential new therapeutics or supplement antibiotics. Trends Biotechnol. 2010;28: 591–595. DOI: 10.1016/j.tibtech.2010.08.001
44. Valerio N., Upton A., Roberts S.A. et al. Effects of single and combined use of bacteriophages and antibiotics to inactivate E. coli. Virus Res. 2017;240:8–17. DOI: 10.1016/j.virusres.2017.07.015
45. Pires D.P., Melo L., Vilas Boas D. et al. Phage therapy as an alternative or complementary strategy to prevent and control biofilmrelated infections. Curr. Opin. Microbiol. 2017;39:48–56. DOI: 10.1016/j.mib.2017.09.004
46. Domingo-Calap P., Delgado-Martinez J. Bacteriophages: protagonists of a post-antibiotic era. Antibiotics. 2018;7(3):66–82. DOI: 10.3390/antibiotics7030066
47. Kim P.J., Attinger C.E., Olawoye O. et al. Negative pressure wound therapy with instillation: review of evidence and recommendations. Wounds. 2015;27:12, S2–S19.
48. Gupta S., Gabriel A., Lantis J., Teot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int. Wound J. 2016;13(2):159–174. DOI: 10.1111/iwj.12452
49. Kurbangaleyev S.M. Purulent infection in surgery (Principles and methods of treatment). Moscow: Medicine, 1985: p. 185. (In Russian).
Review
For citations:
Bryusov P.G., Lishchuk A.N., Potapov V.A. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine (Russian Journal). 2022;100(9-10):439-446. (In Russ.) https://doi.org/10.30629/0023-2149-2022-100-9-10-439-446
Views:
563
Email this article 