Laboratory Studies

See the list below:

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

See the list below:

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

See the list below:

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.

Treatment & Management

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Media Gallery

Pectoralis major muscle flap blood supply and options for sternal coverage (a, b, c).
Rectus abdominus muscle flap and eighth intercostal perforator for coverage of sternal defects.
Omentum flap showing its blood supply based on the right or left gastroepiploic arteries.
Latissimus dorsi can be used as an island flap to cover the anterior chest and sternal defects.
Open, infected sternal wound before debridement.
Infected sternal wound.
Chest wall reconstructed with pectoralis major myocutaneous flap.
Chest wall infection after debridement of all nonviable and infected tissue.
Chest wall reconstructed with right unilateral pectoralis major muscle flap for sternal wound closure.
Harvesting of transverse rectus abdominis myocutaneous (TRAM) flap to cover sternal defect. In this case, the internal mammary artery (IMA) was previously harvested for a coronary artery bypass graft.
Chest wall reconstruction following sternal infection using a free transverse rectus abdominis myocutaneous (TRAM) flap.

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Author

Mark A Grevious, MD, FACS Chairman, Division of Plastic and Reconstructive Surgery, John H Stroger, Jr Hospital of Cook County

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, Association for Academic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS Chicago Medical School at Rosalind Franklin University of Medicine and Science

Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Ginard I Henry, MD Plastic, Reconstructive, and Hand Surgeon, Stonegate Plastic Surgery, Lakeland Health

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 and Dental Associations, 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 Assistant Professor of Surgery, Department of Cardiovascular and Thoracic Surgery, University of Louisville and Jewish Hospital

Kendra J Grubb, MD, MHA is a member of the following medical societies: American College of Surgeons, American Medical Association, Association of Women Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

Chief Editor

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

Dennis P Orgill, MD, PhD Professor of Surgery, Harvard Medical School; Assistant in Surgery (Plastic Surgery), Boston Children's Hospital

Dennis P Orgill, MD, PhD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Institute for Medical and Biological Engineering, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, Association of Academic Chairmen in Plastic Surgery, Hidradenitis Suppurativa Foundation, Plastic Surgery Research Council, Tissue Engineering and Regenerative Medicine International Society, Wound Healing Society

Disclosure: Received consulting fee from Integra LifeSciences, Inc for consulting; Received consulting fee from Integra LifeSciences, Inc. for program and training services agreement; Received grant/research funds from Integra LifeSciences, Inc. for clinical research; Received grant/research funds from KCI for basic science research; Received grant/research funds from KCI for clinical research; Received consulting fee from DSM for consulting; Received consulting fee from Musculoskeletal Transplant Foundatio.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous authors Sanjay K Sharma, MD, and Saleh M Shenaq, MD†, to the development and writing of this article.