Case 45 Sternal Wound Infection
45.1 Description
Anterior midline chest wall wound measuring roughly 20 cm×6 cm in size
The sternal edges and mediastinum are exposed; upon presentation, the image demonstrates gross purulence and necrotic edges
With serial debridement, an extensive underlying dead space is evident (blue dotted line); no vascular grafts are visible
45.2 Work-Up
45.2.1 History
Etiology: Sternal wound infection (following median sternotomy), tumor resection, and radiation (ulcers, osteoradionecrosis)
Duration wound has been present
Current wound care regimen
Comorbidities: Respiratory insufficiency, sepsis, and cardiac disease
Review previous operative reports (e.g., what vessels have been used and ribs resected)
45.2.2 Physical Examination
Vital signs: Is the patient stable?
Size and depth of defect
Presence of infected or necrotic tissue
Sternum stability with respirations
Sternal wires/plates/other hardware present
Exposed grafts, vascular devices, or mediastinum (e.g., pericardium, pleura)
Prior surgical scars on chest or abdomen
Congenital abnormalities: Poland syndrome and pectus excavatum/carinatum
45.2.3 Pertinent Imaging or Diagnostic Studies
Operative culture data, consider fungal infection for late-presenting mediastinitis
Chest X-ray (CXR): For presence of sternal wires and evaluation of lung fields
Computed tomography (CT) scan: Evaluation for deep abscesses in case of persistent fevers and sepsis
Magnetic resonance imaging (MRI): Most useful in chronic sternal defects for evaluation of extent of infection and/or osteomyelitis
Angiogram: Allows study of available vessels and their patency
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