Thomas J Francel, MD, Nicholas T Kouchoukos, MD

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Presentation transcript:

A rational approach to wound difficulties after sternotomy: the problem Thomas J Francel, MD, Nicholas T Kouchoukos, MD The Annals of Thoracic Surgery Volume 72, Issue 4, Pages 1411-1418 (October 2001) DOI: 10.1016/S0003-4975(00)02008-7

Fig 1 The flow diagram that is used on evaluation of a patient postmediasternotomy shows the importance of sternal stability in the eventual care of this patient. (A) Wound problems include localized erythema and drainage or systemic signs (increased white blood cells, fever, chills, lethargy). (B) Culture all drainage to help dictate correct antibiotic therapy. (C) Requires debridement, cultures, and evaluation of mediastinum for area of undrained sepsis. (D) Beware of risk for right ventricular laceration. (E) Choice of donor muscle is dependent upon the volume of the mediastinal defect, except ipsilateral rectus, which may not be immediately available after internal mammary artery harvest. The Annals of Thoracic Surgery 2001 72, 1411-1418DOI: (10.1016/S0003-4975(00)02008-7)

Fig 2 Bimanual alternating chest compressions are used for diagnosing sternal stability. Any movement of sternal edges or clicks is diagnostic of sternal instability. The Annals of Thoracic Surgery 2001 72, 1411-1418DOI: (10.1016/S0003-4975(00)02008-7)

Fig 3 Sometimes a deep infection will present with local surrounding skin erythema. In this patient it is shown along the right upper chest where there is still evidence of the examiner’s fingerprints. The Annals of Thoracic Surgery 2001 72, 1411-1418DOI: (10.1016/S0003-4975(00)02008-7)

Fig 4 (A) Patient A exhibits all of the characteristics that will allow early rewiring of the patient. The bone stock is healthy and there is a minimal mediastinal defect. (B) Patient B shows an extensive bone loss with a moderate mediastinal defect. (C) Patient C exhibits a deep mediastinal defect that requires multiple flap reconstruction for healing. The Annals of Thoracic Surgery 2001 72, 1411-1418DOI: (10.1016/S0003-4975(00)02008-7)