Sternal Wound Infection


Sternal Wound Infection

Louis H. Poppler & Thomas H. H. Tung
Intraoperative consultation on a 67-year-old woman who had undergone three-vessel coronary artery bypass (left internal mammary and saphenous vein grafts) with subsequent sternal infection and wound dehiscence.


  • Patient with evidence of an anterior midline chest wall wound measuring roughly 15 × 8 cm.

  • The sternal edges and mediastinum are exposed without evidence of gross purulence or extensive necrotic tissue.

  • No vascular grafts are visible.



  • Etiology: Sternal wound infection (following median sternotomy), tumor resection, radiation (ulcers, osteoradionecrosis).

  • Duration of wound.

  • Current wound care.

  • Comorbidities: Respiratory insufficiency, sepsis, cardiac disease.

  • Review previous operative reports (e.g., vessels used, ribs resected).

Physical examination

  • Vital signs: Is the patient stable?

  • Size and depth of defect.

  • Presence of infected or necrotic tissue.

  • Exposed grafts, vascular devices, or mediastinum.

  • Prior surgical scars on chest or abdomen.

  • Congenital abnormalities: Poland syndrome, pectus excavatum/carinatum.

Pertinent imaging or diagnostic studies

  • Chest X-ray: Presence of sternal wires and evaluation of lung fields.

  • Computed tomography: Evaluation for deep abscesses if persistent fevers and sepsis.

  • Magnetic resonance imaging: Most useful in chronic sternal defects for evaluation of extent of infection and/or osteomyelitis.

  • Angiography: Allows study of available vessels and their patency.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Sternal Wound Infection

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