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.

1. Sears, E. D., Wu, L., Waljee, J. F., Momoh, A. O., Zhong, L., Chung KC. The Impact of Deep Sternal Wound Infection on Mortality and Resource Utilization: A Population-based Study. World J Surg. 2016 Nov;40(11):2673–80.

2. Schiraldi, L., Jabbour, G., Centofanti, P., Giordano, S., Ab delnour E., Gonzalez M. et al. Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery. Arch Plast Surg. 2019 Jul;46(4):291–302.

3. Khashkhusha, A., Butt, S., Abdelghaffar, M., Wang, W., Rajananthanan A., Roy S., et al. Sternal Wound Reconstruction Following Deep Sternal Wound Infection: Past, Present and Future: A Literature Review. J Cardiovasc Dev Dis. 2024 Nov 7;11(11):361.

4. Phoon, P. H. Y, Hwang, N. C. Deep Sternal Wound Infection: Diagnosis, Treatment and Prevention. J Cardiothorac Vasc Anesth. 2019 Sep;S1053077019309802.

5. Liu, Y. T., Lin, S. H., Peng, C., Huang, R. W., Lin, C.H., Hsu, C.C., et al. Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis. Int J Surg Lond Engl. 2024 Nov 14;110(12):8107–25.

6. Protasevich, A. I., Tatur, A. A. Predictors of complica- tions after radical resection and plastic surgeries in patients with postoperative anterior purulent mediastinitis. Surgery. Eastern Europe. 2025;2(14):199–212. doi: 10.34883/PI.2025. 14.2.022 (in Russian)

7. Wu, W.S., Chen, L.R., Chen, K.H. Platelet-Rich Plasma (PRP): Molecular Mechanisms, Actions and Clinical Appli cations in Human Body. Int J Mol Sci. 2025 Nov 6;26(21):10804.

8. Zhang, G., Song, Y., Zhuang, T., Zhao, Y., Pan, Z., Pan, Z. Clinical application and research progress of platelet-rich plasma. Hematology. 2025 Dec 31;30(1):2549159.

9. Potapnev, M. P., Krivenko, S. I., Bogdan, V. G., Kosmacheva S. M., Shlyaga O. L., Karpenko F.N. Platelet-rich derived plasma: Manufacture and medical application. Healthcare. 2018;10:38–44 (in Russian).

10. Ahmed, A. B., Thatcher S., Khorsandi J., Ahmed Z., Lee M., Jaouhari A., et al. Platelet-Rich Plasma (PRP) and Recombinant Growth Factor Therapies in Cutaneous Wound Healing: Mechanisms, Clinical Applications, and Future Directions. J Clin Med. 2025 Dec 3;14(23):8583.

11. Sun, Y., Zhu, M., Qiu, L. Efficacy of mesenchymal stem cells and platelet-rich plasma therapies on wound healing: A Systematic Review and meta-analysis. Regen Ther. 2025 May 19;30:75–91.

12. Li, Y., Wang, X., Li, Y, Li, D., Li, S., Shen C. Efficacy and safety of allogeneic platelet-rich plasma in chronic wound treatment: a meta-analysis of randomized controlled trials. Sci Rep. 2024 Oct 24;14:25209.

13. Troyanov, A. A., Kondratenko, G. G., Potapnev, M. P., Hrapov, S. I., Krivenko, S. I., Levandovskaya, O. V. Pervyj klinicheskij opyt mestnogo lecheniya kozhnyh porazhenij pri saharnom diabete s pomoshch’yu plazmy, obogashchennoj rastvorimymi faktorami trombocitov. Medicinskij zhurnal, 2018, № 1, 116–120. (in Russian)

14. Protasevich, A. I., Tatur, A. A., Efficiency of vacuum therapy in the treatment of postoperative sternomediasti- nitis: a systematic review and metaanalysis. Surgical News. 2016; 3(24):275–224. doi 10.18484/2305–0047.2016.3.275. (in Russian).

15. He, S., Tang, N., Li, S. Comparison of negative pressure wound therapy with conventional wound care in the treatment of sternal wound infection after cardiac surgery: A meta-analysis with trial sequential analysis. PloS One. 2025;20(8):e0328771.

16. Piwnica-Worms, W., Azoury, S. C., Kozak, G., Nathan, S., Stranix, J. T., Colen, D. et al. Flap reconstruction for deep sternal wound infections: factors influencing morbidity and mortality. Ann Thorac Surg. 2020 May;109(5):1584–90.

17. White, B. M., Meyer D. L., Harlin S. L. Is Negative-Pres - sure Wound Therapy a ‘Bridge to Reconstruction’ for Poststernotomy Mediastinitis? A Systematic Review. Adv Skin Wound Care. 2019 Nov;32(11):502–6.

18. Yao, D., Feng, G., Zhao, F., Hao, D. Effects of plate letrich plasma on the healing of sternal wounds: A metaa nalysis. Wound Repair Regen Off Publ Wound Heal Soc Eur Tissue Repair Soc. 2021 Jan;29(1):153–67.

19. Song Y., Chu W., Zhang M., Liu Z., Li D., Zhao F. et al. A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet-rich plasma and negative pressure trauma therapy. Int Wound J. 2023 Nov;20(9):3457–66.

20. Tian, B., Yang, X., Liu, Y., Wei, C., Liu, D., Ren, X. et al. The application effect of autologous platelet-rich plasma combined with negative pressure sealing drainage technology in pressure ulcer wound repair. Medicine (Baltimore). 2024 Nov 1;103(44):e39672.

21. Qian, K., Bao, W. X., Zuo, N., Wang, S., Ding, W. The sy nergistic effects of platelet-rich plasma and negative pres- sure wound therapy in cavitary infected wounds: a singlecentre experience. J Int Med Res. 2024 Nov 23;52(11): 03000605241300064.

22. Arora, K., Chaudhary, P., Kapila, R. Proficiency of topical platelet-rich plasma with vacuum-assisted closure over platelet-rich plasma alone in diabetic foot ulcers – A clinical prospective comparative study. Nat. J Physiol Pharm Pharmacol. 2022. 12 (9). 1414–1420 doi: 10.5455/njppp.2022.12.00135202219012022