milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2026.4.136milmed-813Research ArticleСЛУЧАЙ ИЗ ПРАКТИКИCASE FROM PRACTICEКомплексное лечение послеоперационного переднего медиастинита с использованием терапии ран отрицательным давлением и плазмы, обогащенной растворимыми факторами тромбоцитовComplex management of postoperative anterior mediastinitis with negative pressure wound therapy and platelet-rich plasma: a case reportПоповМ. Н.PopovM. N.

г. Минск

Minsk

КилимиченкоА. В.KilimichenkoA. V.

г. Минск

Minsk

ПротасевичА. И.ProtasevichA. I.

г. Минск

Minsk

КондратенкоГ. Г.KondratenkoG. G.

г. Минск

Minsk

ПотапнёвМ. П.PotapnevM. P.

г. Минск

Minsk

ГалицкаяВ. Ю.GalitskayaV. Yu.

г. Минск

Minsk

УЗ «10-я клиническая больница»Беларусь10th Clinical HospitalBelarusУО «Белорусский государственный медицинский университет»БеларусьEducational Institution «Belarusian State Medical University»BelarusРеспубликанский научно-практический центр трансфузиологии и медицинских биотехнологийБеларусьRepublican Scientific and Practical Center for Transfusiology and Medical BiotechnologiesBelarus20262710202604136139Copyright © Попов М.Н., Килимиченко А.В., Протасевич А.И., Кондратенко Г.Г., Потапнёв М.П., Галицкая В.Ю., 20262026Попов М.Н., Килимиченко А.В., Протасевич А.И., Кондратенко Г.Г., Потапнёв М.П., Галицкая В.Ю.Popov M.N., Kilimichenko A.V., Protasevich A.I., Kondratenko G.G., Potapnev M.P., Galitskaya V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/813

Описан клинический случай лечения пациента 57 лет с послеоперационным передним медиастинитом, развившимся после стернотомии и реваскуляризации миокарда по поводу ишемической болезни сердца с постинфарктным кардиосклерозом. Пациент поступил в 10 ГКБ г. Минска спустя 2 месяца после аорто-маммарокоронарного шунтирования. В условиях первичного стационара были выполнены рестернотомия, санация перикарда и рео - с теосинтез по Робичеку. При переводе на первом этапе после хирургической обработки раны применялась терапия раны локальным отрицательным давлением на фоне системной антибактериальной  и симтоматической терапии. После купирования глубокой стернальной инфекции и стабилизации состояния пациента произведены субтотальная резекция грудины с удалением передних отрезков 2–7 ребер с обеих сторон и бипекторальная торакомиопластика. Возникший краевой некроз кожно-подкожных лоскутов потребовал этапных некрэктомий с адъювантным использованием метод вакуум-ассистированного закрытия раны (VAC-терапия) и аллогенной плазмы, обогащенной растворимыми факторами тромбоцитов.Через 4,5 месяца потребовалась повторная госпитализация в связи с абсцессом переднего средостения и гнойными свищами в области рукоятки грудины. В ходе операции выполнен дебридмент раны  с наложением вакуум-ассистированной повязки. После 4 сеансов VAC-терапии и этапной хирургической обработки рана ушита вторичными швами с применением пластин «Гель тромбоцитарный». Послеоперационный период протекал без осложнений, пациент выписан в удовлетворительном состоянии.

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.

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The authors declare that there are no conflicts of interest present.