Sternal osteomyelitis is infection of the breastbone, most often after open-heart surgery through a sternotomy, and sternal wound dehiscence is when that wound breaks open. Treatment involves antibiotics, thorough debridement of infected bone and wires, often negative pressure therapy, and closure with healthy muscle flaps such as the pectoralis major.
- AnaesthesiaGeneral
- Hospital stayUsually 1 to 3 weeks
- Back to routineTypically 6 to 8 weeks
What is sternal osteomyelitis and sternal wound dehiscence?
After cardiac surgery the sternum (breastbone) is divided and wired back together. In a small proportion of patients the wound becomes infected or separates. Infection may involve only the skin and fat, or extend into the bone (sternal osteomyelitis) and the space behind it (mediastinitis), which is serious.
Risk factors include diabetes, obesity, smoking, chronic lung disease, kidney disease, prolonged surgery or ventilation, and use of both internal mammary arteries for bypass grafting. Signs include wound discharge, redness, pain, a clicking or unstable breastbone, fever and an open wound.
Plastic surgical management focuses on clearing infection and bringing in healthy tissue. Infected and dead bone, cartilage and wires are removed, the wound is often prepared with negative pressure wound therapy, and the defect is closed with well-vascularised muscle, most commonly pectoralis major flaps, with rectus abdominis, latissimus dorsi or omentum as alternatives. Dr. N. Jithendran's gallery shows several sternal osteomyelitis cases treated in this way.
Who is sternal osteomyelitis and sternal wound dehiscence for?
- Patients with infected or discharging sternotomy wounds after heart surgery
- People with sternal wound dehiscence (wound breakdown) or an unstable breastbone
- Patients with chronic sternal sinuses or exposed wires
- People with sternal osteomyelitis from other causes such as radiation
How is it done?
- Cultures, blood tests and CT scan to assess the extent of infection
- Targeted antibiotics
- Radical debridement of infected bone, cartilage and sternal wires
- Negative pressure wound therapy to control infection and prepare the wound
- Closure with pectoralis major advancement or turnover flaps, or rectus abdominis, latissimus dorsi or omental flaps
What is recovery like?
- Hospital stay usually ranges from about one to several weeks
- Antibiotics may continue for several weeks
- Drains are usually removed when output falls
- Avoid heavy lifting and pushing with the arms for about 6 weeks
- Breathing exercises and gradual mobilisation
What are the risks?
- Persistent or recurrent infection
- Wound breakdown or flap loss
- Seroma or haematoma
- Some weakness of the shoulder or arm after pectoralis flap
- Medical complications related to heart and lung conditions
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
What is sternal wound dehiscence?
Sternal wound dehiscence is separation of the breastbone and wound after a sternotomy for heart surgery. It may be caused by infection, poor healing or excessive strain on the wires. Signs include a clicking or moving breastbone, wound discharge and the wound opening. It needs prompt surgical review.
How is an infected breastbone treated?
Treatment combines antibiotics with surgery. Infected bone, cartilage and wires are removed, the wound is often cleaned further with negative pressure therapy, and it is then closed with healthy muscle flaps, most commonly from the pectoralis major, which brings a good blood supply to fight infection.
Who is at higher risk of sternal infection after heart surgery?
Higher risk is seen in people with diabetes, obesity, smoking, chronic lung disease, kidney disease, long operations or prolonged ventilation, and when both internal mammary arteries are used for bypass grafting. Good blood sugar control and wound care help reduce the risk.
Will I need more than one operation?
Often, yes. Many patients need one or more debridements, sometimes with negative pressure dressing changes, before the final flap closure. In selected cases debridement and flap closure can be done together. Your surgeon will plan this based on the infection.
