Sternum healing without wires

[fay1013]

My mother had quadruple bypass in the middle of June. At her 4-week checkup they discovered an area of concern at the bottom of her incision where they felt it wasn't healing properly. She was sent home and the home care nurse was instructed to pack the wound. The following week she went back to see the surgeon because the wound was looking worse - she had a surgical procedure, which included removing two of the wires and debridement, and opened up her incision about 5 inches. They cultured her wound and found psuedonomas and klepsiella. She was sent home with a wound vac and two antibiotics. 4 days later she started to run a fever, and felt a general malaise; the visiting nurse noticed a marked difference and tried getting the surgeon's office to see her that day, but they did not and it was two more days before she was seen again. At this point, 6-weeks after the initial surgery, they decided her best chance to fight the infection was to completely open her incision and remove all the wires. Immediately after the surgery the surgeon informed me of how things went and stated that the wires were not doing much to hold things together at that point, and that she had scar tissue to help stabilize the sternum, and that "later" a plastic surgeon would close the incision. During that hospital stay her wound was cultured again, and this time they detected MRSA. She was discharged this past Sunday on IV antibiotics (stayed with me to take care of the infusions) and yesterday went back in for the procedure by the plastic surgeon. He shifted her pectoral muscles to cover the sternum, and then closed the incision. He said tonight that her sternum is essentially in two pieces, with some fibrous tissue kind of keeping it in place, but that you could reach your finger thru and touch her heart. Needless to say that was somewhat of a disturbing image. He did say that if the  muscle flap held, that her chances of healing without further complications was good, but that it could take a year for the sternum to completely knit back together. So, the question I and her other children have is how much risk is she in with her sternum in that condition, and how limited will she be in what she can do? The surgeon's have both been somewhat vague about this thus far.

[ed34]

Has your mother ever had radiation treatment for cancer?
I'm not really sure what the plastic surgeons are talking about. Her bone mass isn't
degrading and the wires are simply there to hold the bone tightly together while it heals.
The wires aren't there to pull muscles or other tissue together. So when they say the wires weren't really doing much, I wonder what they mean. Normally wires are put around
the two halves of the sternum and then tightly bound together to hold the sternum tight.
Perhaps you should question them on this issue because it really doesn't make sense to me.
One of the biggest problems in such cases is getting enough nourishment into the patient to allow the body to heal itself. With all the medication, many patients have no appetite and don't eat enough. Bloods should be taken to ensure there is enough nourishment and if not, she should be fed through a tube up the nose, into the stomach.
A dietician should be giving advice on what foods to eat.
It seems like a long wait with the wounds, but from what the plastic surgeons have done,
I think things will start to progress now. It's just set backs that are annoying, especially
MRSA. Have they put her into a single room now? with wounds such as your mothers
she is high risk for infection and should be in a single room anyway. You should also
warn visitors who feel they have any infections not to visit. Make sure the nurses are
changing the dressings at LEAST once a day to keep them clean.
With regards to her ability in the future, once the sternum heals, which it will, she will be fine. However, it will take some time by the sound of it. Until the doctor says different, she should not do any lifting. This will put a huge strain on the sternum.
Please keep us informed. I really feel for your mother and what she is going through, and
her family of course. My thoughts are with you.