Complex management of postoperative anterior mediastinitis with negative pressure wound therapy and platelet-rich plasma: a case report

We report a case of a 57-year-old male with postoperative anterior mediastinitis that developed after sternotomy and myocardial revascularization for ischemic heart disease with postinfarction cardiosclerosiss.The patient was admitted to Сlinic № 10 two months after coronary artery bypass grafting. Previous interventions at the referring hospital included resternotomy, pericardial debridement, and Robicsek reosteosynthesis. Upon transfer, our first-stage management consisted of surgical debridement and vacuum-assisted closure (VAC) therapy alongside systemic antibiotic and symptomatic treatment. After сontrol of deep sternal wound infection and patient stabilization, a subtotal sternal resection with excision of the anterior segments of ribs 2–7 bilaterally and bipectoral thoracomyoplasty were performed. The developed marginal necrosis of the skin-subcutaneous flaps required staged necrectomies aided by adjuvant VAC therapy and platelet-rich plasma.4.5 months later, the patient was readmitted for an anterior mediastinal abscess and purulent fistulas at the sternal manubrium. Treatment involved surgical debridement with negative pressure wound therapy. After four cycles of VAC-therapy with intermittent surgical debridement, the wound was successfully closed with secondary sutures using «Platelet Gel» plates. The postoperative course was uneventful, and the patient was discharged in satisfactory condition.