Year 2022 Vol. 30 No 1




Samara State Medical University, Samara,
Samara Regional Clinical Hospital Named after V.D. Seredavin, Samara,
Russian Federation

The case report of a patient with post-sternotomy mediastinitis is presented. A successful case of treatment of such a formidable complication after cardiac surgery was demonstrated. Success in the treatment of such patients depends on the complete cupping inflammatory process in the site of operation, as well as chest wall reconstruction. The positive clinical effect of vacuum-assisted dressings in the treatment of post-sternotomy mediastinitis is shown. The vertical rectus abdominis myocutaneous flap was used as a plastic material to cover a defect in the chest wall. The course of surgery and the result of treatment are described in details. To date, the surgical society has not developed a generally accepted tactic in the treatment of poststernotomy mediastinitis, both at the stage of arresting the infectious process, and in the process of reconstructive and restorative intervention. In practice, along with alloplastic materials, synthetic and metal implants are used. The autologous tissues include muscle flaps and the greater omentum. In thoracic surgery, the rectus abdominis can serve as an alternative to omentoplasty for extended chest wall defects.

Keywords: sternal wound infection, osteomyelitis of the sternum, muscle flap, chest wall defect, chest wall reconstruction, sternum dehiscence, management of mediastinitis
p. 112-118 of the original issue
  1. Merritt RE. Chest Wall Reconstruction Without Prosthetic Material. Thorac Surg Clin. 2017 May;27(2):165-69. doi: 10.1016/j.thorsurg.2017.01.010
  2. Betancourt Cuellar SL, Heller L, Palacio DP, Hofstetter WL, Marom EM. Intra- and Extra-Thoracic Muscle Flaps and Chest Wall Reconstruction Following Resection of Thoracic Tumors. Semin Ultrasound CT MR. 2017 Dec;38(6):604-15. doi: 10.1053/j.sult.2017.07.003
  3. Momeni A, Kovach SJ. Important considerations in chest wall reconstruction. J Surg Oncol. 2016 Jun;113(8):913-22. doi: 10.1002/jso.24216
  4. Billington A, Dayicioglu D, Smith P, Kiluk J. Review of procedures for reconstruction of soft tissue chest wall defects following advanced breast malignancies. Cancer Control. 2019 Jan-Dec;26(1):1073274819827284. doi: 10.1177/1073274819827284
  5. Zhou Y, Zhang Y. Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer: A 10-year retrospective study of chronic radiation-induced ulcers. Medicine (Baltimore). 2019 Feb;98(8):e14567. doi: 10.1097/MD.0000000000014567
  6. Malathi L, Das S, Nair JTK, Rajappan A. Chest wall reconstruction: success of a team approach-a 12-year experience from a tertiary care institution. Indian J Thorac Cardiovasc Surg. 2020 Jan;36(1):44-51. doi: 10.1007/s12055-019-00841-y
  7. Tewarie L, Moza AK, Khattab MA, Autschbach R, Zayat R. Effective Combination of Different Surgical Strategies for Deep Sternal Wound Infection and Mediastinitis. Ann Thorac Cardiovasc Surg. 2019 Apr 20;25(2):102-10. doi: 10.5761/atcs.oa.18-00115
  8. Piwnica-Worms W, Azoury SC, Kozak G, Nathan S, Stranix JT, Colen D, Othman S, Vallabhajosyula P, Serletti J, Kovach S. Flap reconstruction for deep sternal wound infections: factors influencing morbidity and mortality. Ann Thorac Surg. 2020 May;109(5):1584-90. doi: 10.1016/j.athoracsur.2019.12.014
  9. Mitish VA, Usu-Vuiyu OYu, Paskhalova YuS, Ushakov AA., Zvyagin AA, Orudzheva S A, Zhestkov MS. Experience in surgically treating chronic postoperative osteomyelitis of the sternum and ribs after minimally invasive myocardial revascularization Rany i Ranevaia infektsiia. Zhurn im prof BM Kostiuchenka. 2015;2(2):46-55. doi: 10.17 650 / 2408-9613-2015-2-2-46-55 (In Russ.)
  10. van Wingerden JJ. Outcome following sternal reconstruction with the omental flap. J Reconstr Microsurg. 2018 Jun;34(5):e5. doi: 10.1055/s-0038-1668136
  11. Barbera F, Lorenzetti F, Marsili R, Lisa A, Guido G, Pantaloni M. The Impact of Preoperative Negative-Pressure Wound Therapy on Pectoralis Major Muscle Flap Reconstruction for Deep Sternal Wound Infections. Ann Plast Surg. 2019 Aug;83(2):195-200. doi: 10.1097/SAP.0000000000001799
  12. Lee SB, Lee JW, Kim HJ, Ko BS, Son BH, Eom JS, Lee TJ, Ahn SH. Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction: Comparison with conventional mastectomy in a single center study. Medicine (Baltimore). 2018 May;97(18):e0680. doi: 10.1097/MD.0000000000010680
  13. Jeong W, Lee S, Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast. 2018 Apr;38:45-51. doi: 10.1016/j.breast.2017.12.003
  14. Johnstone MS. Vertical Rectus Abdominis Myocutaneous Versus Alternative Flaps for Perineal Repair After Abdominoperineal Excision of the Rectum in the Era of Laparoscopic Surgery. Ann Plast Surg. 2017 Jul;79(1):101-106. doi: 10.1097/SAP.0000000000001137
  15. Nichols DS, Satteson E, Harbor P, DeFranzo A, David L, Thompson JT 2nd. Factors associated with the use of vertical rectus abdominus myocutaneous flap reconstruction following abdominoperineal resection for anorectal cancer. J Surg Oncol. 2020 Oct;122(5):923-27. doi: 10.1002/jso.26086
  16. Netscher DT, Eladoumikdachi F, Goodman CM. Rectus abdominis muscle flaps used successfully for median sternotomy wounds after ipsilateral internal mammary artery ligation. Ann Plast Surg. 2001 Sep;47(3):223-28. doi: 10.1097/00000637-200109000-00001
Address for correspondence:
443079, Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
the Surgery Department of the Institute
of Professional Training,
tel.: +7 9053052755,
Medvedchikov-Ardiia Mikhail A.
Information about the authors:
Medvedchikov-Ardiia Mikhail A., PhD, Thoracic Surgeon of the Surgical Thoracic Department, Samara Regional Clinical Hospital Named after V.D. Seredavin, Associate Professor of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
Korymasov Evgeny A., MD, Professor, Head of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
Benyan Armen S., MD, Associate Professor, Minister of Health Care of Samara Region, Thoracic Surgeon of the Surgical Thoracic Department, Samara Regional Clinical Hospital named after V.D. Seredavin, Professor of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
Contacts | ©Vitebsk State Medical University, 2007-2023