Abstract: a comparative analysis of the treatment results of 47 patients with diffuse purulent mediastinitis who underwent programmed retoracotomy and sanitation of the inflammation in the mediastinum was performed. Patients were divided into 2 groups depending on the features of programmed retoracotomies, sanitation of the foci of purulent inflammation in the mediastinum and targeted prevention of purulent-necrotic tissue damage in the thoracotomy wound. Group I consisted of 18 patients who, when conducting a programmed retoracotomy, were not prevented from wound complications associated with it. In group II, in 29 patients with DHM, a programmed retoracotomy additionally performed temporary fixation of the ribs, which reduces the risk of wound complications associated with retoracotomy. Most patients were operated on later than 12 hours after the onset of the disease. Moreover, in group I, 13 (72.2%), and in group II, 23 (79.4%) patients received surgical benefits later than 24 hours. Against this background, in 14 (77.8%) patients in group I and in 24 (82.8%) in group II, the condition at admission was regarded as serious. Moreover, the severity of the condition and the duration before the provision of specialized medical care, the studied groups were comparable and did not significantly differ from each other (P> 0.05). To prevent wound complications, a device was developed that reduces the risk of infection and temporary fixation of the ribs in the wound area, which reduces trauma to the edges of the wound and ribs during retoracotomy (RF patent for the invention No. 2474389). The device consists of brackets and locks to reduce the edges wounds after retoracotomy with minimizing trauma to the tissues of the chest wall and ribs. Depending on the anatomical features of the patient’s chest, braces and locks of different sizes are used. At the final stitching, the staples were removed and the wound was sutured in layers. Indications for the completion of retoracotomies were: the absence of foci of purulent inflammation in the mediastinal tissue, the absence of fibrin overlay; “transparent” effusion of less than 50 ml; lack of failure of the anastomosis of the esophagus or the place of suturing of the esophagus. The criteria for assessing the effectiveness of the prevention of infectious complications after programmed retoracotomies were the dynamics of indicators of lipid peroxidation (LPO), antioxidant activity (AOA) and medium-molecular peptides (MMP) in the blood serum, the total number of infectious complications and wound complications. A comparative analysis of the treatment results showed that the use of prophylaxis of purulent-necrotic complications in the area of a thoracotomy wound is pathogenetically justified, as it can significantly reduce the number of wound complications.
Keywords: mediastinitis, retoracotomy, programmed debridement, wound infection, complications, mortality, pathogenesis