[Wound infection management in early period after sternotomy]

To describe appropriate treatment strategy at the Petrovsky National Research Center of Surgery and compare results for stable chest and sternum diastasis.

Treatment results were analyzed in 91 patients between October 2022 and December 2024. Patients with sternum diastasis < 4 mm were assigned to group 1 (n=21), patients with severe diastasis - group 2 (n=70). In group 1, negative pressure therapy followed by secondary sutures was used, in group 2 - extended necrectomy with wound defect closure by muscle flaps.

In group 1, 5 (23.8%) patients had no clinical effect from therapy and required necrectomy and wound repair. Mortality rate was 4.8% and 8.6% (p=0.56), early recurrence of infection - 9.5% and 22.8% (p=0.18), mean hospital-stay - 10.1±3.6 and 19.8±5.4 days (p=0.03), respectively. Two-year survival was about 95% in both groups, and incidence of infection recurrence was higher in group 2 (23% after 2 years).

Chest wall stability may be decisive in choosing treatment strategy. Vacuum therapy is effective in patients without sternal diastasis. Mortality rate in early and long-term period after treatment was comparable in both groups.