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Sternal exploration or closure

Definition

When you have open heart surgery, the surgeon makes a cut (incision) that runs down the middle of your chest bone (sternum). The incision hopefully heals itself. But sometimes, people have 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.

Alternative Names

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

Description

The health care team will do exploration and closure procedures to treat the sternal wound. They usually take care of this in the operating room. They will:

  • Remove the wires holding the sternum together
  • Do tests of the skin and tissue in the wound to look for signs of infection
  • Remove dead or infected tissue in the wound (debride the wound)
  • Rinse the wound with salt water (saline)

After the wound is cleaned out, your surgeon may not close the wound. Your surgeon may pack the wound with a dressing, which will be changed often.

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

  • There is a vacuum pump, a foam piece cut to fit the wound, and a vacuum tube
  • A clear dressing is taped on top
  • The foam piece is changed every 2 to 3 days

Your surgeon may put a chest harness on you to 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 a muscle flap from your buttocks, shoulder, or upper chest to cover and close the wound.

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 the infection
  • Stabilize the sternum and chest

Before the Procedure

If your health care team thinks you may have an infection in your chest incision, they may:

  • Take samples from the drainage, skin, and tissue
  • Take a sample of the breastbone for a biopsy
  • Do blood tests
  • Assess how well you are eating and getting nutrients
  • Give you 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.
  • Go to a nursing facility

At either place, you will receive antibiotics for 4 to 6 weeks in your veins (IV).

Outlook (Prognosis)

These complications can cause problems such as:

  • A weakened chest wall
  • Chronic pain
  • Decreased lung function
  • Increased risk of death
  • More infections
  • Need to repeat or revise the procedure

References

Haycock C, Laser C, Keuth J, Montefour K, Wilson M, Austin K, Coulen C, Boyle D. Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery. Journal of Cardiovascular Nursing. October 2005; 20(5):299-305. PMID: 16141774 http://www.ncbi.nlm.nih.gov/pubmed/16141774.

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.

Singh, K., Anderson, E. Harper, J.G. Overview and management of sternal wound infection. Semin Plast Surg. Feb 2011; 25(1): 25-33. PMID: 22294940. http://www.ncbi.nlm.nih.gov/pubmed/22294940.

Review Date: 
9/26/2014
Reviewed By: 
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.