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  • • Can occur in ribs or sternum

    • In past, caused by typhoid or TB

    • Sternal infections common after median sternotomy

    • -Increased risk among diabetics in whom bilateral internal mammary arteries have been used for coronary artery bypass grafting

    • In children, caused by hematogenous infection

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Epidemiology

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  • Ribs: Due to hematogenous osteomyelitis, which is rare except in children

    Sternum: Occurs in 1-2% after sternotomy

    • Often gram-positive, but occasionally due to TB

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Symptoms and Signs

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  • Sternum: Postoperative wound infection or medistinitis

    • Serous drainage increases suspicion

    • Sternal click signifies nonunion of bone and may be due to infection

    • Erythema

    • Fever

    • Fluctuance

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Laboratory Findings

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  • • Elevated WBC count

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Imaging Findings

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  • Chest x-ray: Substernal air may be deep infection

    • CT scan can confirm

    • PET scan

    • Gallium scan

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  • • Differentiate superficial from deep infection using imaging studies and clinical suspicion

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Rule Out

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  • • Costal cartilage infection

    • Bone tumor

    • Cartilage tumor

    • Tietze syndrome

    • Chest wall metastasis

    • Eroding aortic aneurysm

    • Bronchocutaneous fistula

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  • • Physical exam

    • Chest x-ray

    • CT scan

    • Gallium or PET scan if questionable

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  • • Differentiate superficial from deep infection

    • -Topical antibiotics, wound packing, IV antibiotics for superficial infection

      -Surgery for deep infection

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Surgery

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Indications

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  • Deep infection: Aggressive debridement with cultures and muscle flap closure

    • Debridement and closed drainage system is alternate method of treatment

    • Continue IV antibiotics

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Medications

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  • • IV antibiotics

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Treatment Monitoring

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  • • Temperature, continued drainage, healing of bone, and pain

    • Can be difficult to clear infection

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References

Mansour KA, Anderson TM, Hester TR: Sternal resection and reconstruction. Ann Thorac Surg 1993;55:838.  [PubMed: 8466335]
Pairolero PC, Arnold PG, Harris JB: Long-term results of pectoralis major muscle transposition for infected sternotomy wounds. Ann Surg 1991;213:583.  [PubMed: 2039289]

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