Postoperative Sternal Complications

Abstract

There is a large spectrum from mild to life-threatening complications including sternal instability, wound healing disorder, and infected sternal instability with sepsis at its far end. Pathogenesis is discussed controversially, but various risk factors such as obesity, osteoporosis, chronic-obstructive lung disease, prolonged ventilation time, and bilateral use of the internal mammary artery during coronary bypass surgery have been identified. As the laboratory evaluation is often unremarkable, diagnosis is primarily established by palpation and thoracic computed tomography. Restabilization of the sternum can be achieved with rewiring or plate fixation and reconstructive coverage of the defect by plastic surgery in the case of extensive bone loss. Infected superficial wounds can be cleaned of necrotic tissue and thereafter closed again. Large defects and extensive infection with uncertain spread are mostly treated with negative-pressure wound therapy (NPWT); definite closure follows once the bottom of the wound is clean. Closed chest tube drainage with irrigation system may serve as alternative in less severe infection.