Extent-Guided Staged Management of Localized Late-Onset MSSA Sternal Infection after Bilateral Lung Transplantation:...

Sternal infection after lung transplantation is uncommon but life-threatening; late-onset cases may be difficult to diagnose when signs are subtle.

A 38-year-old female developed methicillin-susceptible Staphylococcus aureus sternal infection with bacteremia 7 months after bilateral lung transplantation. Computed tomography (CT) showed a localized abscess around the sternal wires.

CT and intraoperative findings confirmed that infection was confined to extrathoracic peri-sternal tissues without communication with the thoracic cavity. This guided debridement, drainage, wire removal, antimicrobial therapy, and negative-pressure wound therapy (NPWT) with instillation and dwell time followed by standard NPWT.

After infection control and adequate granulation, delayed primary closure was performed 60 days after debridement without flap reconstruction. She was discharged on day 77, without recurrence, 8 months after closure.

Careful assessment of infection extent may help identify patients with localized infection suitable for staged management, permitting delayed primary closure without flap reconstruction.