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Sternal exploration or closure

VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection

When you have open heart surgery, the surgeon may make a cut (incision) that runs down the middle of your chest bone (sternum). The incision usually heals on its own. But sometimes, there are complications that require treatment.

Two wound complications that can happen within 30 days of open heart surgery are:

• Infection in the wound or chest bone. The symptoms can be pus at the incision, a fever, or feeling tired and sick.
• The sternum separates into two. The sternum and chest become unstable. You might hear a clicking sound in the sternum when breathing, coughing, or moving around.

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Description

To treat the complication, the surgeon reopens the area that was operated on. The procedure is done in the operating room. The surgeon:

• Removes the wires holding the sternum together.
• Does tests of the skin and tissue in the wound to look for signs of infection.
• Removes dead or infected tissue in the wound (debride the wound). The breast bone may be removed.
• Rinses the wound with salt water (saline).

After the wound is cleaned out, the surgeon may or may not close the wound. The wound is packed with a dressing. The dressing will need to be changed daily.

Or your surgeon may use a VAC (vacuum-assisted closure) dressing. It is a negative pressure dressing. It increases blood flow around the sternum and improves healing.

The parts of VAC dressing are:

• Vacuum pump
• Foam piece cut to fit the wound
• Vacuum tube
• Clear dressing that is taped on top

The foam piece is changed every 2 to 3 days.

Your surgeon may put a chest harness on you. This will make the chest bones more stable.

It may take days, weeks, or even months for the wound to be clean, clear of infection, and finally heal.

Once this occurs, the surgeon may use wire to bring the bone back together then close the skin or use a muscle flap to cover and close the wound. The flap can be taken from your buttocks, shoulder, or upper chest.

Why the Procedure Is Performed

You may have already been receiving wound care or treatment and antibiotics.

There are two main reasons for doing exploration and closure procedures for the chest wound after heart surgery:

• Get rid of an infection
• Stabilize the sternum and chest

Before the Procedure

If the surgeon thinks you have an infection in your chest incision, the following is usually done:

• Samples are taken from the drainage, skin, and tissue
• A sample of the breastbone is taken for a biopsy
• Blood tests are done
• You'll be assessed for how well you are eating and getting nutrients
• You'll be given antibiotics

After the Procedure

You will likely spend at least a few days in the hospital. After that, you will either go:

• Home and follow-up with your surgeon. Nurses may come to your home to help with care.
• To a nursing facility for further help recovering.

At either place, you may receive antibiotics for several weeks in your veins (IV) or by mouth.

Outlook (Prognosis)

These complications can cause problems such as:

• A weakened chest wall
• Long-term (chronic) pain
• Decreased lung function
• Increased risk of death
• More infections
• Need to repeat or revise the procedure

References

Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg. 2016;152(4):962-972. PMID: 27555340 pubmed.ncbi.nlm.nih.gov/27555340/.

Yepuri N, Pruekprasert N, Cooney RN. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 12. 

Review Date: 7/17/2022  

Reviewed By: Mary C. Mancini, MD, PhD, Cardiothoracic Surgeon, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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