Comparative analysis of the results of plastic replacement of non-extensive sternum defects in patients with deep postoperative sternomediastinitis

Purpose of the study : to increase the effectiveness of plastic replacement of non-extensive sternum defects through the use of de-epidermized skin-fascial flaps. Material and methods . To perform this work, a cohort study model was selected in the form of a retrospective analysis of medical records of patients treated for postoperative sternomediastinitis. 119 medical records were selected for comparative analysis, according to the criteria for inclusion in this study. Depending on the method of plastic replacement of the bone-soft tissue defect of the anterior chest wall, patients were divided into 3 groups: 1 st group (56 patients) – plastic surgery with T-shaped deepidermized skin fascial flaps; 2nd group (29 patients) – plastic surgery with a flap of the pectoral muscle and 3 rd group (34 patients) – rheosteosynthesis of the sternum with fixators made of inert materials. The effectiveness of plastic replacement of the sternum defect was evaluated using computed tomography of the chest organs (elimination of diastasis between the sternum flaps, absence of signs of destruction of the sternum bone tissue) and microbiological studies (conducting a series of seeding of the discharge from the wound and drains to determine complete elimination or reduction of the level of CFU/g of microbial agents to 103). The obtained values were subjected to statistical analysis. Results . Analysis of the results of the study showed that the recurrence rate of deep sternal infection in patients of 1 st and 2 nd groups did not significantly differ. However, in case of complications during transplantation of a flap of the pectoralis major muscle, the likelihood of recurrence of sternomediastinitis increases. A comparison of patients in 1 st and 3rd groups demonstrated that the incidence of recurrence of sternomediastinitis was significantly higher after sternal rheosteosynthesis. Conclusion. The method of plastic surgery with skin fascial flaps proposed by the authors is effective in plastic replacement of non-extensive sternal defects and has a number of advantages compared with conventional methods due to its lower invasiveness and a tendency to reduce the frequency of recurrence of sternal infection.