Shafer Y. Optimization of surgical correction of complications after sternotomy and their prevention in patients with cardiac surgery.

Thesis for a Candidate of Medicine degree by specialty 14.01.03 - Surgery. - Kharkiv Medical Academy of Postgraduate Education, 2020 The thesis presents the results of a study of 576 patients with cardiac surgery who underwent a longitudinal median sternotomy. According to the results of the study, the main factors in the development of complications of this cohort of patients in the preoperative, intraoperative and postoperative period were identified. A new method of sternography, which has significantly improved the results of surgical treatment of cardiac surgery patients, has been developed. The method of hemostasis of the sternum with a hemostatic sponge based on gelatin, which was introduced in a set of actions to combat the complications of sternotomy, led to a significant reduction in bleeding, and, consequently, to the absence of sternomediastinitis in patients included in the study. The effectiveness of a comprehensive approach to the prevention of complications of longitudinal sternotomy using the developed method of sternoraphy and the use of a hemostatic sponge based on gelatin have been proven. The use of multidimensional statistical models of diagnosis and prediction revealed a 6-fold reduction in unsatisfactory results of osteosynthesis of the sternum using the developed technique of sternography, the effectiveness of gelatinous sponge based on gelatin in 5 times compared with the use of classic wrapping sutures and hemostatic wax. The use of the method of 8-shaped wire metal sutures reduces the average stay of the patient in the cardiac surgery department for 5 days. The algorithm of treatment of patients with sternomediastinitis using the method of VAC-therapy developed and implemented in practice allowed to halve both the time of wound cleansing in superficial and deep sternal infection and the time of hospitalization of patients. Key words: median sternotomy, sternomediastinitis, VAC therapy.