Sternal Infection

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mainframe

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Seems like a pesky infection continues to plauge me. I had an open wound right above a sternal wire that removed in July. The wound has been slow to heal and now another smaller open occurred a couple of inches below. I had made an appointment with the general surgeon who removed the sternal wire in July who had been out of the office for a couple of weeks. This is set for Monday of next week.

Last Wednesday, I had a pace maker check at the cardiologist's office. The nurse who saw me suggested I see a thoracic surgeon and the nurse suggested she would chat with my cardio. I figured it was more of a suggestion than anything, but I get a call on Friday that my cardio had made a emergency referral to a specific thoracic surgeon.

I saw the thoracic surgeon on Monday and he suggested he should go in there for a debridment and a plastic surgeon would participate and like do a muscle flap revision if necessary. He didn't think my bone was infected, most likely just the tissue and/or wires.

Anyone have this done? Are you happy with the result?

I'm a little nervous about the surgery and the end result. I'd be great to look normal when this is done, but the plastic surgeon I saw today wasn't making any promises saying it was reconstructive rather than aesthetic.

Nervous is Seattle.
 
mainframe said:
Seems like a pesky infection continues to plauge me. I had an open wound right above a sternal wire that removed in July. The wound has been slow to heal and now another smaller open occurred a couple of inches below. I had made an appointment with the general surgeon who removed the sternal wire in July who had been out of the office for a couple of weeks. This is set for Monday of next week.

Last Wednesday, I had a pace maker check at the cardiologist's office. The nurse who saw me suggested I see a thoracic surgeon and the nurse suggested she would chat with my cardio. I figured it was more of a suggestion than anything, but I get a call on Friday that my cardio had made a emergency referral to a specific thoracic surgeon.

I saw the thoracic surgeon on Monday and he suggested he should go in there for a debridment and a plastic surgeon would participate and like do a muscle flap revision if necessary. He didn't think my bone was infected, most likely just the tissue and/or wires.

Anyone have this done? Are you happy with the result?

I'm a little nervous about the surgery and the end result. I'd be great to look normal when this is done, but the plastic surgeon I saw today wasn't making any promises saying it was reconstructive rather than aesthetic.

Nervous is Seattle.
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I'm sorry to hear this. I remember when you were having the problems with healing so they removed your wires. Did they do any cultures then during surgery?

AS for sternal debridment and muscle flap, Justin had that. His plastic surgeon did a great job and you can't tell anything is different unless you look very close at his chest there is a very small divit where the pec muscle was moved from. His problem was caught pretty early (10 days post op) they removed the wires (except the very top one that was far from any infected tissue and removed any sternum that was bad and a border around the infected areas, just to be sure they got it all. They used his right pec muscle because he is a lefty. He also had infection under his sternum in the tissue that they cleaned out.

I know this has been probably going on for months, but am a little surprised they didn't admit you right away to get on antibiotics ect. What kind of surgeon is doing the surgery? Have you considered going to either Miller or who did your first OHS?
 
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Greg, my breathing is fine, no problems to speak of. No bloodwork ordered yet but I've had quite a bit in last several months this has been lingering. No tempature.

The wound care nurse I saw this morning said he didn't see any infection. But you know surgeons. You go see them and big surprise they want to do surgery. I think the thinking is something is going on to cause my skin over the incision to keep opening up and better to take care of it now than later.
 
Hi Chris,
I don't have anything else to add except to say that I am sorry to hear that you are going through more issues! You certainly had enough with last year's ordeal. I am sending positive thoughts your way and prayers that this whole 'sternal' situation gets sorted out soon.
Thinking of you,
 
Chris, I hope they get in there and it turns out to be much smaller of a problem then they are expecting. I'm sorry you are still having to deal with these issues. Please keep us posted.


Kim
 
So sorry Chris you are still facing some issues. You will be in my thoughts. Hang in there!
 
I've had similar issues since my re-do AVR in May of this year. A couple parts of my wound opened up and I had it looked it by a bunch of people. Early on I met with a CT surgeon at my local hospital who wanted to do what your guy is proposing now, muscle flap with plastic surgeon. I then sought a second opinion from a CT surgeon at my main center and he said he would not operate, that it appeared superficial. For the past 4 months I've been undergoing ambulatory wound care with consultation by an infectious disease doc. Although the infectious disease specialist was very worried early on, my wound has been (slowly) healing since then and he no longer thinks I have or ever had a deep infection. He's had me on antibiotics for four months and counting. Basically, for months my situation has oscillated between panic and "totally superficial". Right now the pendulum is on superficial and I hope it stays that way.

The ID specialist said the real test will be when I go off antibiotics, to see if anything opens up again. He doesn't think it will, but if it does I'd probably be in line for something like you're going to have.

Best of luck with your situation. Just make sure to get good docs, and an infectious disease specialist. Infection detection is like sleuth-work; I've learned it's not easy to determine if you've got a deep infection. It's a tough situation, because we're all used to the heart stuff and know our echos inside and out; this was foreign to me and quite alarming. I'm sure it is to you too. Hang in there.
 
Thanks Lyn,

I know Justin had this done and was hoping you'd reply. Good to hear he ended up with a great result. Some of the pictures on the internet give me concern though. The surgeon is a thoracic surgeon, whether he does alot of valve work or not doesn't really concern me as I'm sure this happens to an equal amount of bypass patients. He's on the Best Doc list a magazine up here does each year and he did surgery on a relative who had lung cancer and had a good result. Funny no one has mentioned the word antibiotic.

Dave good luck with your situaton. This all is a bit overwhelming. While I've dealt with the open wounds for a few months now, the idea of another pretty big surgery isn't something I'm chomping at the bit for. They tell me that while the wounds may briefly close, they are likely to reopen again in the future until the infection is removed. Glad you've found a less invasive treatment.
 
mainframe said:
Thanks Lyn,

I know Justin had this done and was hoping you'd reply. Good to hear he ended up with a great result. Some of the pictures on the internet give me concern though. The surgeon is a thoracic surgeon, whether he does alot of valve work or not doesn't really concern me as I'm sure this happens to an equal amount of bypass patients. He's on the Best Doc list a magazine up here does each year and he did surgery on a relative who had lung cancer and had a good result. Funny no one has mentioned the word antibiotic.

Dave good luck with your situaton. This all is a bit overwhelming. While I've dealt with the open wounds for a few months now, the idea of another pretty big surgery isn't something I'm chomping at the bit for. They tell me that while the wounds may briefly close, they are likely to reopen again in the future until the infection is removed. Glad you've found a less invasive treatment.
Click to expand...

IF you have any specific questions feel free to pm or email me.
The reason I asked about surgeons, is Hopefully it is just the sternum that has problems, but I know I mentioned before , when they did Justin's debriment surgery/muscle flap and what the plan was for the surgery he almost had this year, was to see where the infection (if there is one) is, they shoot some special blue dye and where ever it goes to is infected and needed cut out. Justin's infection ended up being a few spots in his sternum, but also under it (mediastinitis) the BIG fear both then and when he almost had the surgery in jan (but the infection cleared up so they wanted to give him 1 more chance to see if it was really gone since he has had so many surgeries and it had been 2 years so chances are his his heart would be fused to his sternum again) was they were really worried about his heart and conduit and hoped they were fine. Thankfully the infection didn't go to his heart, but just incase I wanted the best heart surgeon in the OR incase they needed to do anything with his heart. To me it was one of those better safe than sorry type things.
 
mainframe said:
...............................Funny no one has mentioned the word antibiotic.

......................
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Chris, I was on twice daily IV antibiotics before I was released in July but then three weeks later the infection returned with a vengance and THAT is when my trouble started ..I have learned to live quite nicely with the flap procedure and find although a slow process pretty much full recovery is still in my future
 
Chris, this must be so frustrating for you. I hope you are able to get some advice in order to give you some comfort in what you are facing. I know I have been having sternum issues too and my fear is that they may want to go in and remove wires. It scares me to think of surgery so soon. Keep us updated, good luck, we will all be thiking of you. :)
 
mainframe said:
Thanks Lyn,

I know Justin had this done and was hoping you'd reply. Good to hear he ended up with a great result. Some of the pictures on the internet give me concern though. The surgeon is a thoracic surgeon, whether he does alot of valve work or not doesn't really concern me as I'm sure this happens to an equal amount of bypass patients. He's on the Best Doc list a magazine up here does each year and he did surgery on a relative who had lung cancer and had a good result. Funny no one has mentioned the word antibiotic.

Dave good luck with your situaton. This all is a bit overwhelming. While I've dealt with the open wounds for a few months now, the idea of another pretty big surgery isn't something I'm chomping at the bit for. They tell me that while the wounds may briefly close, they are likely to reopen again in the future until the infection is removed. Glad you've found a less invasive treatment.
Click to expand...



I was thinking about what you said about some of the pictures you've seen on the internet giving you some concern. I know the kinds you are talking about, with incisions and stitches all over. I wanted to add, or make clear, that for Justin's pect muscle flap, they didn't make any more incisions to get to and move the muscle. His plastic surgery did everything thru his sternal incision (I don't know how, just grateful for Justin's sake thats how he did it) Also since the muscle flap was the last part of the surgery, (a heart surgeon did the debriment and cleaned the tissue around his heart) he did the closing too, something that made Justin happy when they were telling us all about what they would be doing, he liked knowing plastics would close him.

PS, about the antibiotics, we took Justin in because he had another dissolving stitch that didn't dissolve work it way out and he had some oozing. When they checked him, they didn't like how his sternum felt, so admitted him right away and started heavy duty antibiotics before they even did all the testing and knew there definately was an infection just to be safe,(the xray and echo looked fine, they did a CT scan about 9pm that night and it showed a pocket under his sternum). He stayed on those antibiotics until the cultures came back a couple days later that showed what antibiotics for for his bacteria.
 
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