Skip to main content

Health Encyclopedia

Search the Health Encyclopedia

Sternal exploration or closure

Definition

When you have open heart surgery, the surgeon makes a cut (incision) that runs down the middle of your chest bone (sternum). The incision hopefully heals itself. But sometimes, people have complications that require treatment.

Two wound complications that can happen within 30 days of open heart surgery are:

  • Infection in the wound or chest bone. The symptoms can be pus at the incision, a fever, or feeling tired and sick.
  • The sternum separates into two. The sternum and chest become unstable. You might hear a clicking sound in the sternum when breathing, coughing, or moving around.

Alternative Names

VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection

Description

The health care provider will do exploration and close the sternal wound. They usually take care of this in the operating room. They will:

  • Remove the wires holding the sternum together
  • Do tests of the skin and tissue in the wound to look for signs of infection
  • Remove dead or infected tissue in the wound (debride the wound)
  • Rinse the wound with salt water (saline)

After the wound is cleaned out, your surgeon may not close the wound. Your surgeon may pack the wound with a dressing. The dressing will be changed often.

Or your surgeon may use a VAC (vacuum-assisted closure) dressing. It is a negative pressure dressing. It increases blood flow around the sternum and improves healing.

The parts of VAC dressing are:

  • Vacuum pump
  • Foam piece cut to fit the wound
  • Vacuum tube
  • Clear dressing that is taped on top

The foam piece is changed every 2 to 3 days.

Your surgeon may put a chest harness on you. This will make the chest bones more stable.

It may take days, weeks, or even months for the wound to be clean, clear of infection, and finally heal.

Once this occurs, the surgeon may use a muscle flap to cover and close the wound. The flap can be taken from your buttocks, shoulder, or upper chest.

Why the Procedure Is Performed

You may have already been receiving wound care or treatment and antibiotics.

There are two main reasons for doing exploration and closure procedures for the chest wound after heart surgery:

  • Get rid of the infection
  • Stabilize the sternum and chest

Before the Procedure

If your provider thinks you may have an infection in your chest incision, they may:

  • Take samples from the drainage, skin, and tissue
  • Take a sample of the breastbone for a biopsy
  • Do blood tests
  • Assess how well you are eating and getting nutrients
  • Give you antibiotics

After the Procedure

You will likely spend at least a few days in the hospital. After that, you will either go:

  • Home and follow up with your surgeon. Nurses may come to your home to help with care.
  • To a nursing facility.

At either place, you may receive antibiotics for several weeks in your veins (IV) or by mouth.

Outlook (Prognosis)

These complications can cause problems such as:

  • A weakened chest wall
  • Chronic pain
  • Decreased lung function
  • Increased risk of death
  • More infections
  • Need to repeat or revise the procedure

References

Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 12.

Singh K, Anderson E. Harper JG. Overview and management of sternal wound infection. Semin Plast Surg. 2011;25(1):25-33. PMID: 22294940 www.ncbi.nlm.nih.gov/pubmed/22294940.

Review Date:9/17/2016
Reviewed By:Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.

Health
Outcome Data

No data available for this condition/procedure.

Health Encyclopedia

More Features

We Appreciate Your Feedback!
1. Did you find this information useful?
         Yes
         No
2. Would you recommend this website to family and friends?
         Yes
         No