Post-sternotomy complications

Post-sternotomy
complications • Sternal dehiscence (on chest radiograph) - Ganzer Fall bei Radiopaedia
Hacking C, Sternal dehiscence (on chest radiograph). Case study, Radiopaedia.org (Accessed on 15 Dec 2023) https://doi.org/10.53347/rID-66472 • CC by-nc-sa 3.0 (modified)
Supportive
treatment using a compression garment vest of painful sternal instability following deep surgical wound infection: a case report. A computed tomography (CT) scan prior to supportive therapy showing sternal non-union (two months after operative refixation).
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Post-sternotomy complications comprise of a varied range problem that can occur at varying durations after a median sternotomy. Imaging playing in detection and aiding management.

Epidemiology

Complication rates for median sternotomy have been reported to range from 0.5-5%, with mortality rates from these ranging from 7-80%

Pathology

They are perhaps best divided into presternal, sternal and post-sternal compartments:

Presternal
  • cellulitis
  • sinus tract formation
  • presternal abscess formation
Sternal
Post-sternal/retrosternal
  • infection - inflammation related 
  • retrosternal hematoma 

Differential diagnosis

  • expected post-surgical appearances: can persist for around 2-3 weeks
    • small foci of mediastinal gas: usually resolve by around 7 days postoperatively but can persist longer
    • defects in the sternum (including of gaps up to 4 mm in width)
    • step-offs (sternal tables at different levels)
    • impaction (overriding of the sternal halves)
Siehe auch:
Assoziationen und Differentialdiagnosen zu Komplikationen nach Sternotomie:
Osteomyelitis
des Sternums
surgicalcasereports.springeropen.com • CC-by-4.0