STERNAL WOUND INFECTION AND DEHISCIENCE
One of the miracles of modern surgery is the ability to perform open chest procedures to bypass clogged coronary arteries, repair traumatic injuries, remove tumors and clear the pleural space of infection. Such procedures usually go well, but like any operation, can take a turn for the worse.
Patients who suffer sternal wound infection and dehiscience after chest surgery may have painful recoveries, suffer severe complications or even die.
Usually, skin bacteria such as Staphylococci and Streptococci are involved in these infections, but other organisms such as fungi and mycobacteria can also cause problems.
If the bony edges of the split sternum become infected (osteomyelitis), they may come apart. Breathing and coughing put tension on the wires holding the sternal halves together, and they may pull out of the softened bone. This can allow the sternum to spring open, ripping the overlying skin and making a direct route into the patient’s chest cavity for bacteria and air. Patients with this complication must reach a hospital with an ICU quickly.
The picture below shows what sternal wound infection & dehiscience looks like.
This video shows sternal wound infection & dehiscience. You can see the respiratory motion of the two halves of the sternum, with the beating heart behind them. An abscess had formed in the chest wall, and the sternal bone was infected. The wires holding the sternum together pulled out of the softened bone, and were removed when the surgeon drained the abscess and cleaned everything up.
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The spaces surrounding each lung are under negative pressure relative to our atmosphere, helping our lungs inflate on each breath. When the chest is opened, that vacuum-assist disappears, and the lungs collapse. Patients who have had chest surgery usually have a thoracostomy tube or two in place after their procedure, attached to a vacuum hose to help re-inflate the lungs. Once their wounds have healed a bit, allowing the chest to again maintain its seal, the tubes can be removed.
After sternal bone debridement (clean-up), rewiring and wound closure, the patient usually needs thoracostomy tubes and a prolonged course of intravenous antibiotics to try and penetrate the infected bone. The antibiotic course may run for 6 weeks or more, and the infection can recur again, even years after apparently successful therapy.