eMedicine Specialties > Plastic Surgery > Chest

Chest Reconstruction, Sternal Dehiscence: Workup

Author: Mark A Grevious, MD, FACS, Assistant Professor of Surgery, Associate Program Director, Division of Plastic and Reconstructive Surgery, University of Illinois at Chicago
Coauthor(s): Raja Ramaswamy, MS, The Chicago Medical School; Ginard I Henry, MD, Assistant Professor of Surgery, Section of Plastic Surgery, Medical Student Faculty Coordinator, University of Chicago Pritzker School of Medicine; Plastic Surgeon, Weiss Memorial Hospital; Rani Ramaswamy, MS, Rosalind Franklin University of Medicine and Science/The Chicago Medical School; Kendra J Grubb, MD, MHA, Resident Physician, Department of General Surgery, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Apr 13, 2009

Workup

Laboratory Studies

    • Obtain aspiration of fluid collections for culture and analysis.
    • Obtain wound cultures if clinical deterioration of the patient or further signs of breakdown are observed (ie, increased erythema, drainage, separation of incision).
    • Wound cultures should include quantitative microbiology count, tissue specimen for analysis, and sternal bone biopsies for culture.
    • Obtain a CBC with differential, blood cultures, C-reactive protein levels.
    • Prealbumin and transferrin levels are often important in preoperative nutrition assessment.

Imaging Studies

    • Plain radiographs (anteroposterior [AP] or posteroanterior [PA]) may detect air in the mediastinum; a sternal stripe reflects air between separated sternal halves.
    • Ultrasonography may be performed.
    • CT scanning can accurately detect sternal disruption, pockets of fluid, abscess, or pleural effusions.

Other Tests

    • MRI can be used to diagnose osteomyelitis or other pathologic processes (eg, recurrent tumor).
    • Bone scans to determine osteomyelitis may have a limited value for the acute wound because of the presence of inflammation and tracer uptake.
    • Bone cultures more accurately assist in making the diagnosis of osteomyelitis in the clinical setting.

More on Chest Reconstruction, Sternal Dehiscence

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Workup: Chest Reconstruction, Sternal Dehiscence
Treatment: Chest Reconstruction, Sternal Dehiscence
Follow-up: Chest Reconstruction, Sternal Dehiscence
Multimedia: Chest Reconstruction, Sternal Dehiscence
References
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References

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Further Reading

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Keywords

sternal dehiscence, thoracic reconstruction, trunk reconstruction, wound healing, wound healing pictures, wound treatment, wound closure, chest wound closure, sternal wound healing, sternal wound pictures, sternal wound closure, plastic surgery, sternotomy, chest reconstruction, sternal dehiscence, midline sternotomy incision, midline sternotomy, sternal wound dehiscence, wide debridement, mediastinitis, sternal instability, post tumor resection, sternum reconstruction, vacuum-assisted closure device, VAC, rigid fixation of the sternum, thoracoacromial system, internal mammary arteries, flap transposition, median sternotomy, internal mammary artery, IMA, coronary bypass surgery wound

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Contributor Information and Disclosures

Author

Mark A Grevious, MD, FACS, Assistant Professor of Surgery, Associate Program Director, Division of Plastic and Reconstructive Surgery, University of Illinois at Chicago
Mark A Grevious, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, and Association for Academic Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS, The Chicago Medical School
Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Ginard I Henry, MD, Assistant Professor of Surgery, Section of Plastic Surgery, Medical Student Faculty Coordinator, University of Chicago Pritzker School of Medicine; Plastic Surgeon, Weiss Memorial Hospital
Ginard I Henry, MD is a member of the following medical societies: American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, California Medical Association, Christian Medical & Dental Society, and National Medical Association
Disclosure: Nothing to disclose.

Rani Ramaswamy, MS, Rosalind Franklin University of Medicine and Science/The Chicago Medical School
Disclosure: Nothing to disclose.

Kendra J Grubb, MD, MHA, Resident Physician, Department of General Surgery, University of Illinois at Chicago
Kendra J Grubb, MD, MHA is a member of the following medical societies: American College of Surgeons, American Medical Association, and Association of Women Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Orgill, MD, PhD, Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Isologen Corporation Grant/research funds Principle Investigator; Massachusetts Institute of Technology Royalty None; Brigham and Women's Hospital Royalty None; Regenesis Corporation Scientific Advisory Board Consulting; Kinetic Concepts, Inc. Expert Witness None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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