A rational approach to wound difficulties after sternotomy: the problem.

One hundred fifty-one patients with mediastinitis after median sternotomy were treated by a single surgeon over a 6-year period. The infections were analyzed in regard to the depth of infection, time of presentation, and the mediastinal defect. Preoperative evaluations included computed tomographic (CT) scans, testing for sternal stability, and the level of contamination. Intraoperative evaluations included bone, inflammatory tissues, Gram stain, and cultures. Treatment options included rewire procedures (20 patients), immediate reconstruction (63 patients), or delayed reconstructions (88 patients). The issues of exposed prosthetic material, right ventricular laceration, long-term intravenous antibiotics, Candida infections, and reexploration of the healed mediastinum after flap reconstruction are discussed. The overall approach to postoperative healing difficulties after sternotomy is examined.