Evidence-Based Management of a Deep Sternal Wound Infection and Complete Thoracic Dehiscence

Abstract

This report emphasizes the importance of a staged treatment approach that is consistent with evidence- based recommendations for the management of deep sternal wound infection in a patient with multiple risk factors. A 64 year old male patient presented six months following aortic valve replacement via a median sternotomy with a deep sternal wound infection that had resulted in complete dehiscence of the thoracic wall and partial exposure of the pericardial sac. Treatment during the six months prior to the referral included several standard reconstructive attempts consisting of debridement, stainless steel wiring, IV antibiotics, and negative pressure wound therapy without improvement. As he was metabolically decompensated, the metabolic abnormalities were corrected, and the patient underwent full -thickness debridement of the chest wall wound and sternum. The sternum was approximated using the Sternal ZIPFIX® System (DePuy Synthes). The left pectoralis major island flap was used to cover the sternum for re-vascularization to aid with treatment of sepsis and improve bony union. Antibiotic pellets were added prior to closure of the wound. In June 2016, the patient underwent debridement and closure of the chest wound. The patient is now five years post-operative, and is able to carry out all activities including long distance motorcycle riding.