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CURRENT ISSUE

№4' 2020

SURGERY

International Medical Journal, Vol. 26., Iss. 4, 2020, P. 25−28.


DOI (https://doi.org/10.37436/2308-5274-2020-4-4)

OSTEOMYELITIS OF STERNUM: DIAGNOSIS AND SURGICAL TREATMENT


Valerii Volodymyrovych Boiko, Viktor Nikolaevich Lykhman, Myroshnychenko D. O., Shafer Ya. V., Sergei Valerevich Tkach, Andrei Alekseevich Merkulov, Bilodid Ye. O., Nedilko O. V.

State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv
Kharkiv National University of Internal Affairs, Ukraine

Postoperative sternomediastinal infections significantly affect morbidity and mortality, as well as the hospitalization duration and treatment cost for cardiac surgery patients. The use of median sternotomy has a number of complications, primarily infectious, which can occur with the formation of superficial or deep wound infection, diastase and fragmentation of the sternum, and sometimes with destabilization of the chest bony skeleton. The development of sternal osteomyelitis is associated with a significant reduction in long−term survival. The results of treatment for the patients with the sternum osteomyelitis after sternotomies, being at the State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the NAMS of Ukraine" in Kharkiv within the period of 2014−2020, have been analyzed. Diagnosis of patients with osteomyelitis of the sternum comprised fistulography, multispiral computed tomography, ultrasound. The material for the bacterial study was the discharges of a sternal wound. Antibiotic susceptibility of isolated bacterial cultures was studied by disco−diffusion and in agar. There were 32 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. Among antibiotics, the most effective in vitro were lincomycin and especially carbapenems (imipenem). When treating the patients with sternal osteomyelitis, VAC therapy was used, as well as open wound management by dressings depending on the wound process stage. The results of the study suggest that multi−slice computed tomography should be preferred in the diagnosis of osteomyelitis of sternum, which allows the diagnosis verification in 98 % of cases, and the use of ultrasonography is important to monitor the clearance and healing of sternotomy wounds. The use of VAC therapy has helped to reduce the length of hospital stay of patients.

Key words: sternum osteomyelitis, VAC therapy, multispiral computed tomography, bacterial culture.


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