Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with post-sternotomy wound dehiscence following CABG. Symptoms include localized erythema, purulent discharge, and sternal instability (clicking sensation). No systemic signs of sepsis currently noted. Duration of symptoms: [Insert days]. Previous interventions: [Insert antibiotics/debridement].
Clinical Examination Findings
Physical examination reveals a midline sternal wound with evidence of deep tissue infection. Sternal edges are palpable and mobile, suggesting osteomyelitis or mediastinitis. Wound bed shows necrotic tissue, slough, and malodorous purulence. Surrounding skin is indurated and erythematous. No evidence of exposed hardware or graft involvement at this time.
Treatment Protocol
Surgical management plan: Urgent surgical debridement of necrotic sternal tissue and infected cartilage. Obtaining deep tissue cultures for microbiology. Initiation of empiric IV antibiotic therapy pending culture results. Consideration for vacuum-assisted closure (VAC) therapy followed by secondary reconstruction using pectoralis major muscle flaps or omental flap transposition.