This article presents an observation of a clinical case in a patient with the postoperative sternomediastinitis. In cardio-thoracic surgery this complication ranges from 1 to 10 % [2, 3, 14, 16, 19] depending on who the work is done by and the ratio of deaths can reach up to 40 % [13]. Due to untimely diagnosis of the pyoinflammatory process in the tracheostomy orifice, the patient developed progressive instability of the sternum followed by sternomediastinitis. A two-staged tactics of treatment of the postoperative sternomediastinitis using the technique of negative pressure followed by two-flap omentoplasty according to K. Yoshida in this case is the technique of choice for surgical treatment, which allows to restore the integrity of the chest wall frame in the shortest possible time and ensure tightness for the mediastinum. This technique is the most effective in the treatment of destructive forms of purulent complications of the sternum after a median sternotomy. The relevance and expediency of the use of omentoplasty is also justified from a financial and medico-social position, since the procedure reduces mortality among patients of this category, as well as the risk of severe disability at the able-bodied age.

Objective. To present the results of surgical treatment of patients with multifocal atherosclerosis based on a differential approach of surgical strategy. Materials and methods. During the period of 20142021 in the S.G. Sukhanov Federal Center for Cardiovascular Surgery, Perm, we operated 243 patients with combined atherosclerosis of coronary and carotid arteries; 104 (42.8 %) patients underwent a one-stage coronary and carotid artery surgeries, and 139 (57.2 %) patients underwent a staged correction of pathology. Critical lesion of the coronary arteries was revealed in 16 (6.6 %) patients, single-vessel critical lesion in 24 (9.9 %), two-vessel and three-vessel critical lesion was detected in 87 (35.8 %) and 79 (32.5 %) patients, respectively. 145 (59.7 %) patients had a critical lesion of the carotid arteries, and 16 (6.58 %) had a bilateral critical lesion. We have developed an algorithm for choosing treatment tactics in patients with concomitant atherosclerotic lesions of the coronary and carotid arteries. Depending on our differential approach, we selected 104 (42.8 %) patients who underwent a one-stage surgery, and 139 (42.8 %) patients who were subjected to a staged treatment. Results. A total hospital mortality was 0 %. In the staged group, 1 case of transitory ischemic attack (TIA) (0.7 %) was recorded, in the group of combined interventions there was no TIA. In the group of combined interventions, there were 3 (2.9 %) cases of the perioperative stroke and 1 (0.9 %) case of myocardial infarction. In the group that underwent staged interventions, there were 2 (1.4 %) cases of perioperative stroke and 2 (1.4 %) cases of myocardial infarction. Both groups had similar combined results (death, acute MI, stroke) 5 (3.6 %) for the staged group and 4 (3.8 %) for the combined one. There was no significant difference in any of the endpoints. Conclusions. The proposed approach to the choice of techniques for treatment of combined lesions of the carotid and coronary arteries based on the differential approach is safe and permits to adequately eliminate the lesions.