Management of extensive sternal and costochondral osteomyelitis

Abstract

A woman in her 50s, with multiple comorbidities, underwent coronary artery bypass grafting and presented with a deep sternal wound infection (DSWI) a month later. Despite initial debridements, polymicrobial infection continued to develop and persist, leading to chronic sternal osteomyelitis which involved multiple costocartilages and the majority of her manubrium. Over a number of months, she underwent serial debridements, antibiotic treatment and investigations to manage her condition, with multidisciplinary collaboration helping resolve her infections. Successful closure and reconstruction occurred post infection resolution, involving a pedicled latissimus dorsi myocutaneous flap.DSWIs can be challenging to manage and require a timely multidisciplinary approach. Early referral to the plastics team is important for reducing patient morbidity and improving outcomes for the patient. White cell scans should be considered when available to help determine the extent of osteomyelitis in the acute surgical setting. Definitive reconstruction for extensive DSWIs requires the use of vascularised healthy tissue.

Keywords: Bone and joint infections; Plastic and reconstructive surgery.