Post CABG with stermal infection/ hernia

[willistephens]

Nov. 18,2006; I had an inferior wall MI, went into V-fib five times, received a 'clot buster'(Retavase), emergent heart cath = four vessel blockages - directly to OR had a three vessel CABG. Surgeon could not do the fourth blockage(too risky). Post op complications = deep sternal wound infection with Staph Aureus, hypersensitivity reaction to Nafcillin causing bleeding (Hg went down to 7.0) and Renal failure (creatinine went to 5.7). Discharged Dec.15,2006 with a wound vac, PICC line with Cubicin IV antibiotic every day, Procrit for the anemia, Renal diet,and fluid restrictions. Over the next 45 days - infection abetted, kidney function improved(creatinine to 1.2) and anemia resolved (Hg 14.5). Jan 31, 2007, I had a pectoral muscle flap to close the deep sternal wound. Started cardiac rehab on April 4,2007. Friday, after exercising at rehab, I noticed a soft bulge, a lump about the size of the palm of my hand at the bottom of the sternal incision(border of diaphragm and stomach). I could push it in and it appeared flat, upon releasing my hand, it would bulge back out. It did not hurt, nor was it red or hot to touch. On April 20, 2007, I did have an EGD with dilatation of an esphageal stricture. What do you think. A hernia? More Surgery? I am 165 pounds, 68 yrs. old,non-smoker,no alcohol, not diabetic, only meds are lopressor 50 mg twice a day, levothyroxine 12.5 mcg every day, nexium 40 mg every day, one 81mg aspirin a day. I was on lopid, crestor and requip for restless leg, but my PCP took me off them D/T Hemogobin and Hematocrit dropped from 14.5 and 45.3 to 12.7 and 34.7. Any one ever have their incision herniate??  

[Archibald S Miller III, MD,FACS]

You have a direct surgical hernia. It can be repaired and it is usually done by a plastic surgeon. A sheet of dermis is placed into the area preventing the bulge.This problem is fairly common. If you have pain, fix it, and if not it probably will not cause long term problems it will just not get  better.Respectfully,

                       arch s miller ms md facs