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Management of extensive sternal and costochondral osteomyelitis

Aroun Kalyana1, Ravi De Silva2, Kai Yuen Wong3

  • 1School of Clinical Medicine, University of Cambridge, Cambridge, UK ak2308@cam.ac.uk.

BMJ Case Reports
|August 14, 2025
PubMed

Insights

Deep sternal wound infections (DSWIs) after cardiac surgery are complex. This case highlights successful management of chronic sternal osteomyelitis using serial debridements, antibiotics, and flap reconstruction.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Plastic Surgery

Background:

  • Deep sternal wound infections (DSWIs) are serious complications following cardiac surgery.
  • A patient with comorbidities developed a persistent, polymicrobial DSWI leading to chronic sternal osteomyelitis.

Purpose of the Study:

  • To describe the management of a complex case of chronic sternal osteomyelitis post-coronary artery bypass grafting.
  • To emphasize the importance of a multidisciplinary approach and advanced reconstructive techniques for DSWI.

Main Methods:

  • Serial debridements and targeted antibiotic therapy were employed.
  • White cell scans were considered for assessing osteomyelitis extent.
  • Reconstruction utilized a pedicled latissimus dorsi myocutaneous flap.

Main Results:

  • The multidisciplinary team successfully resolved the chronic polymicrobial infection.
  • The patient underwent successful closure and reconstruction with a myocutaneous flap.
  • The management strategy led to a positive patient outcome.

Conclusions:

  • DSWIs necessitate a prompt, multidisciplinary approach for optimal patient outcomes.
  • Early plastic surgery consultation is crucial for minimizing morbidity.
  • Vascularized tissue transfer is essential for reconstructing extensive DSWIs.

Keywords:
Bone and joint infectionsPlastic and reconstructive surgery

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