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Patient with osteomyelitis of sternum

Patient after CABG 8 months ago. In the long-term period, diastasis of the sternum developed, requiring its resynthesis. Subsequently, purulent fistulas formed with long-term osteomyelitis. Was admitted to our clinic for treatment. The first operation is the removal of wire sutures, costal cartilage, sternum sequesters and opening of four sub-sternal abscesses.

37 days Vac therapy with debridminten using the Söring ultrasonic cavitator
view of wound after 1.5 months of VAK
first attempt at wound closure
a sub-sternal abscess opened unexpectedly
a catheter was placed for irrigation of the abscess cavity into the sequestrectomy area and resection of the abscess cavity

All over again. Three more weeks of VAK therapy. The second “approach” to close the wound with a displaced flap.

The wound is cleansed. The edges of the wound are excised. Formed two flaps to close the defect.
The wound is sewn up. Rubber strips left for drainage. The symmetry is observed.
A VAC bandage was applied on top for maximum adhesion of the skin to granulations.
The final form of the wound after removing the stitches

p.s. chronic infection led to anemia and kidney failure. In connection with suspicion of amyloidosis, bone marrow and subcutaneous adipose tissue were taken for analysis. Fortunately, it was not confirmed.