Post-sternotomy chronic osteomyelitis: is sternal resection always necessary?

Abstract

Post-sternotomy chronic osteomyelitis can be successfully treated mainly by systemic antimicrobial therapy alone, without mandatory surgical treatments, provided that accurate microbiological and radiological studies are performed. The presence of CoNS and Corynebacterium species seemed to be associated with a need for a prolonged combined antimicrobial therapy with a minimum of 6 months up to a maximum of 18 months. The CT scan and the 3D reconstruction of the sternum proved to be a good method to evaluate the status of the sternum and support the treatments. The VAC therapy was not useful in treating osteomyelitis, although, if used appropriately in the postoperative deep sternal wound infection with the sponge fitted between the sternal edges, it seems to be an effective method to eradicate the infection in the sternum and to prevent chronic osteomyelitis.

The role of surgical debridement in different clinical manifestations of invasive aspergillosis

“…Both were presenting with a sterno-cutaneous fistula, needing aggressive surgical debridement, wire removal and resection of the infected cartilage. 50 A similar case also requiring extensive cartilage debridement was reported recently. 53 Dotis and Roilides investigated 46 cases of osteomyelitis due to Aspergillus spp.…”

“…were isolated from the sternum. Both were presenting with a sterno‐cutaneous fistula, needing aggressive surgical debridement, wire removal and resection of the infected cartilage . A similar case also requiring extensive cartilage debridement was reported recently …”

“…Surgical intervention can also help to increase penetration of antifungal agents into the bone (in case of failure of conservative therapy). [47][48][49][50][51][52] Vertebral aspergillosis can lead to catastrophic destruction of the spine, resulting in destabilisation and kyphosis, requiring surgical fusion and/or fixation of vertebrae. In the thoracic spine, the osteomyelitis is mostly caused by haematogenous spread from a pulmonic focus of Aspergillus infection.…”

Combined free flaps with arteriovenous loops for reconstruction of extensive thoracic defects after sternal osteomyelitis

“…Although sternal osteomyelitis might be successfully addressed by means of prolonged conservative antibiotic therapy in very few special cases, it is well known that a radical surgical debridement of all necrotic tissue and removal of infected hardware and biofilm is mandatory for successful treatment of deep and chronic sternal osteomyelitis …”

“…Although sternal osteomyelitis might be successfully addressed by means of prolonged conservative antibiotic therapy in very few special cases, 8 it is well known that a radical surgical debridement of all necrotic tissue and removal of infected hardware and biofilm is mandatory for successful treatment of deep and chronic sternal osteomyelitis. 1,9,10 Regarding defect reconstruction, there are several options for the plastic surgeon mainly depending on the extent of the defect, availability of nutrient and/or recipient vessels, prior operations, and the patients' general state of health.…”