Sternal resynthesis in patients with postoperative sterno-mediastinitis

The aim of the study was to evaluate efficacy and safety of sternal resynthesis by nitinol implants in patients with poststernotomy sternomediastinitis and in animal model. Material and Methods. Surgical nitinol alloy wire mesh implant was developed for sternal resynthesis. The experimental study comprised 60 Wistar rats: sternal tissue was cut by lancet, nitinol alloy wire mesh implant was placed, and wound was closed by suturing layer by layer (experimental animal group). Control animal group comprised sham-operated rats. The signs of swelling, hemorrhage, hyperemia, inflammatory infiltration, regeneration, and reaction to implant were studied histologically at days 14, 28, and 48 post-surgery. Clinical results of surgical treatment for postoperative sternomediastinitis were studied in 29 patients hospitalized during 5-year period (2010-2014). Patients were assigned to 2 groups. Group 1 - n=14; mean age of 62.64±7.69 years; 10 (71.4%) males - underwent sternal resynthesis with placement of nitinol alloy wire mesh implant. Group 2 - n=15; mean age of 61.07±7.86 years; 11 (73.3%) males - underwent surgical debridement with metallo-osteosynthesis (MOS) by metallic suture. Results. Six-week experimental animal study demonstrated no significant adverse reactions between the implant and sternal and parasternal soft tissues. In clinical group 1, successful sternal closure was achieved in 12 patients; mediastinitis resolved in 12 patients; healing by primary intention was observed in 11 patients. No implant-specific complications (fracture, migration, cheese-wiring, severe pain syndrome) were recorded. In group 2, successful sternal closure was achieved in 6 patients; mediastinitis resolved in 8 patients; healing by primary intention was observed in 10 patients. Routine MOS in patients with postoperative complications of medial sternotomy failed to achieve sternal closure in 60% of cases due to failed metallic sutures that aggravated sternal fragmentation. Recurrence of failed sternal sutures occurred more frequently in patients who received routine MOS (р