Management of the recurrent sternal wound infection: MATERIALS AND METHODS (part 3)


Nine months later the patient presented to the emergency room with an abscess at the xiphoid level which spontaneously opened, and drained persistently for two months.
A sinogram and computerized tomographic (CT) scan revealed a subcutaneous tract running superiorly to the lower neck. Exploration was advised when another fluctuant area began to develop at the upper end of the sternotomy scar. Methylene blue was instilled to stain the tract. The caudal portion of the incision was first reopened with careful preservation and retraction of the rectus musculocutaneous flap. The sinus tract adhered to the undersurface of the flap from pedicle to tip. All flap fat was soft and viable with no evidence of fat necrosis. No discrete mediastinal structures could be identified as scar tissue had healed over them. No infectious locus was found.Following removal of all granulation tissues, the original flap again easily filled the majority of the defect created. Unfortunately, superiorly another mesothelial lined cavity near his tracheotomy site was accidently found which was not connected to the sinus tract. To fill this and the residual inferior void, a split right pectoralis major turnover flap based on the first and second segmental perforators was rapidly raised. The wound again healed satisfactorily, although follow-up to date has only been three months. You have a great opportunity to find birth control pills click here to feel one lucky customer.

This entry was posted in Infections and tagged Median sternotomy, Muscle flaps, Sternal wound infection.