Sternal Wound Infection

My dad underwent CABGx4 last month.  Was readmitted about 9 days later with a deep sternal wound infection.  He was taken to the OR to have incision opened up and he is on BID drsg changes and antibx at home now.  They are talking about doing a muscle flap in the next month or so.  I would like some statistics on success rate of this procedure as well as the infection  clearing up.  It seems everything I have read online is from people having many problems and repeated surgeries and grafts after sternal wound infections.  Are there any chances this will work?  My father is a physician himself.  Any literature you can recommend reading?

Thanks

[CCF CARDIO MD JMF]

Dear Marcy,

As you are aware, sternal wound infections are serious and often have protracted courses.  The flap is used to reconstruct this area and is met with good success as long as appropriate antibiotic coverage and dressing changes are instituted.  

You may wish to refer to literature in the plastic surgery field for more information on this.  You may also check with plastic surgery websites for durther information on this.

[Carol]

Hi Marcy,
I had bypass surgery in June of '98 and I too developed a deep infection...my surgeon sent me to a plastic surgeon who advised me to have the muscle flap operation immediately. I was so scared to have another operation as I had had complications from the by-pass that I opted to search around for an alternative method to clear up this infection. With the help of my primary care dr. we decided to do the "open wound" method of healing which entailed a central line being put into the chest wall and being infused every six hours around the clock with a strong antibotic (antibiotic) called timentin---this went on for six weeks. I also had a visiting nurse come every day to cleanse the wound and change the dressing. I realize this method isn't for everyone but it worked for me.....my surgeon, plastic surgeon all thought I should have the flap surgery and were against my trying the open wound method and they were pleasantly surprised that it worked...
The first thing they did was to clean out the incision and by the time they finished the wound was 5 inches long----3 inches wide and 2 inches deep....it took approximately 6 weeks to close completely and during this time I had constant blood tests to determine the level of infection.  I found a lot of the information about open wound healing online and then took it to my primary dr. to see what he thought.
Good luck to your Dad---as I said my method isn't for everyonebut fortunately it worked for me---if you have any questions just email me----***@****

[CCF CARDIO MD JMF]

Dear Carol,
thank you for providing this other approach to caring for these wounds.

[Marcy Brown]

Thanks for the replies.  You don't know how appreciated they are.  This is a great site!  Thanks for all the work.

I do have another question though.  I am wondering whether the flap is done for the infection or for the sternal instability or both.

Today the plastic surgeon suggested going in and ligating the hypogastric artery.  Is this to force collateral circulation to the chest area??  Does this sound like a valid option or a shot in the dark?

In reference to those plastic's site, I have tried and found nothing.  Any specific sites you know of?

Marcy

[CCF CARDIO MD JMF]

Dear Marcy,

Hypthetically this sounds ok.  I am unfamiliar of any literature showing benefit of this approach.