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Allergic to metal, Sternum Wound!
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Allergic to metal, Sternum Wound!

My mother is 62 and had a quad bypass in April 2009 along with complications including HIT syndrome and also a slight stroke. She was released about a month later but continued with a small wound to the lower sternal area. She went to Wound Care around 7/2009 and had a CT scan that supposedly came back without any noted pus pockets.  The radiology report dated 7/31/2009 that compares to the CT done 5/6/2009 says that there has been interval resolution of left lower lobe consolidation and pleural effusion. Minimal right basilar atelectasis is seen. Stranding and minimal amount of fluid is seen tracking along the sternum, new from 5/6/2009. There is mild erosion of the inferior sternum which is consistent with the clinical diagnosis of sternal infection. Sternal infection worse in the inferior aspect with bony erosion. However, the surgeon went ahead and did a debridement and closure of the sinus tract on 8/14/2009. He noted that there was no evidence of pus. There was an old suture granuloma in the region. Cultures wet taken and the wound was washed with antibiotic solution and then closed. Ever since then she has complained about never feeling right and felt that her bones sort of shift when she moves or breathes deep. Ever since the bypass she has had a large lump in the lower aspect of her sternum, which began to drain on 11/6/12. This is where I am trying to get answers!! She has type 2 diabetes mellitus, Rheumatoid arthritis, high cholesterol, coronary artery disease, COPD, vasculitis, peripheral neuropathy.... She was taken back for surgery on 11/9/12 for a small abscess incision & drainage. However, she came out with a hole in her chest the size of a tennis ball! They had to remove 3 wires from her CABG (which she told them in 2009 that she was allergic to metal), removed some cartilage and part of her lower sternum. My mother has no insurance, however, a wound vac was donated along with 6 home health visits. We went to the wound dr today and he said that the wound is not healing and advised to stop the wound vac. Now I am worried! Apparently she has two different infections in this wound. In your opinion what is her prognosis? I appreciate any information that you can offer as I have had to take a crash course in wound cleaning!
Avatar_dr_f_tn
Hello and hope you are doing well.

Understand your predicament. Primarily her diabetes needs to be adequately controlled for proper wound healing and for tackling the infection. Aim for a strict euglycemic state. Then have a culture and sensitivity test done to find out the correct antibiotic that the infecting organism is sensitive to and taking this medication for the required amount of days may help to clear infection. Next check to see if there are any persisting wires which could be triggering an allergic reaction.


Hope this helped and do keep us posted.
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