Reopening of CABG Sternal Incision

It is over a year since my original CABGx4. The incision site still leaks at the base and "proud flesh" keeps filling it, but not healing it. I just saw the plastic surgeon. They want to reopen the incision and see what is causing this. It could be: wires, stitches, infection, ziphoid cartilage, tissue, bone. They won't know until they go in again. Best case: a wire and a little cleaning and antibiotics and stitch closed. Clean the sternum. Worst case: pectoral (or omentom) muscle flap placed over the ruined sternum resulting in weakness and numbness from tummy to shoulders the rest of my life. I've seen pictures on the net, and they are barbaric. Plus, what if I still don't heal and I'll be out of commission for 6-8 weeks (out of sick time). I finally can take in a movie or shop, the holidays are here and I'll be homebound and in a painful recovery. I am terrified and depressed. Anybody been through this? (my original story is with my entry regarding osteomyelitis, abscess and CABG on this site).

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Sternum had hers removed and the flap in place. She'd be the one to talk to about sternum removal.

Did you not notice the incision was leaking prior to this?
I personally would go back to the heart (vascular) surgeon and see what's up. He closed the incision, he would be able to tell you. Sounds like there might have been a drain in there. Also if you are not healing properly you could have diabetes. Check your sugar levels.

I wish you luck.

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This problem has been ongoing since March. So the heart surgeon has been dealing with it--wet-to-dry packing, dry packing, silver nitrate, trimming, wound vac. Now to plastic surgery.

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I hope they have done cultures on the drainage. Is it painful? Reddened? Can they feel the bones moving or clicking when you press on it? Having the incision opened would allow them to at least make sure the bone and wires are intact. My Dad had a sternotomy with a pectoral muscle flap done after his bypass. His wound took forever to heal, but it did heal up eventually. No diabetes, just problems with the nerve endings being all jumbled up causing numbness to the area.

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No cultures done on current drainage, but they say I do not have an infection. It gets red near the opening, but not the whole incision. Painful, yes. No moving bones or clicking. I'm hoping it's just a wire and some cleaning, not a pectoral flap. Terrified. I have diabetes so I am worried about the new incision, etc. healing. How long is "forever" to heal for your dad? And can he lift items now. Is he still in pain? How long ago? Thanks for your input.

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How do they know it's not infected if they haven't cultured it? I'm a nurse....we culture everything! Just because there is a small opening at the bottom end doesn't mean it isn't tunneling upward. Definately sounds like they need to open your incision some and look underneath. Yes your diabetes is a factor in your healing. We now keep all ICU patients especially those having heart surgery on very tight blood sugar control with insulin drips. My Dad was not diabetic. He always complained of his incision feeling numb and his chest just "didn't feel normal". I used to tell him .......well it's not! He had trouble with it healing only because he sat with a cup of hot soup resting on his chest and burned himself quite badly. He could not feel it because of the numbness. He had his surgery back in 1994. He had some limited range of motion to his right shoulder due to them using his pectoral muscle. He was able to lift things just wasn't strong with that arm. He refused any cardiac rehab though so I suppose that may be why. He didn't really have pain.....just a persistent aching. Helped by Darvocet. He did come home from the hospital with a PICC line and received antibiotics for three months post-op. Hope that helps and doesn't scare you.

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Hi there C-Cat:

The only thing I know about you is what you put in your post. If it has been over a year since your surgery, what is the doctors' problem. You have an infection and your diabetis is keeping it from healing quickly. You will have to be ridget in taking care of you diabetis. Do you have a medical care team looking after you or are all the doctors working as individuals.

Please, if they want to go back in, let them. They will be able to determine what the infection is .... wires, stitches, tissue or bone. The only one I have any familiarity with is the bone infection. That would be osteomylitise (sp?). If it has been hanging around this long, it is cronic and doing you no favours.

I don't recall if you said the sternum has been removed or if they may have to remove it. Mine was destroyed by ostermylitise and my coughing from fluid around my lungs shredded it and pulled it from the wires. It sounds like your wires are still intact.
That gives you a big headstart. Have the drs. used an open packing and vac system. That 's what it sounded like. But were they giving you any antibiotics at the same time. Vancomycin through a pic line along with the open packing and vac can clear the infection in much less time than leaving it alone. Longer for Diabetics but it does work.

Talk to your Plastic surgen and ask him which muscle he will be able to use. Your Pecs would be the best since they can be reversed and pulled down to cover the space.

Of course there are going to be problems. If your muscles are left attached on one end stretched to cover another part, you will feel them in the new place. I can only tell you what I deal with.

My sternum is gone, period. My ribs are attached only at my spine. My pecks have been detached at the top and reversed to cover the hole left in my chest. My chest itself is in two pieces and I deal with the left collarbone pressing against my wind pipe if I use my left arm to do something on the right. I lift nothing more than 4 pounds at the most. Heavier than that I have to exert myself and that uses the abdominal muscles which in turn has the organs behind the ribs pressing on them. Pressing like that can cause a rib to go through them. I can no longer hold my arms out and have become an artist of the 3 minute shower and quick tricks with a curling iron. I certainly cannot lie to you and tell you there won't be major changes in your life. But you will have a life and a very good one. Stay optimistic and be open to new ventures. It will be 2 years in May since mine was done and I am still adapting to these new limits and learning some new things and becoming reaquainted with some old pleasureso but didn't get into in any depth before. It is a new chapter in my life and I am enjoying it. For me the worst thing is being unable to drive. I live in a rural area with no bus service. I believe you live in a town or city.

I'm going to stop now. This is enough to take in.
Any questions -- ask away --


Take care and be blessed --- Gloria ---

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C-CAT: I was going to ask you where you found those pictures on the internet. I haven't been able to find any and have been looking for a long time.

Gloria

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To Gloria (Sternum) The link to the pictures is
emedicine.medscape.com/article/1278627-overview
If you can't drive--that would be a big problem for me because I still have to work full-time. Otherwise, I will lose my home. I am really worried about my future. The docs say my heart is good for 20 years, I'm 61 and have house payments for 13 more years, which means I have to work until I'm 74!!!!!!! With my family history, I didn't think this would be an issue as everyone before me died between the ages of 48 and 53. My original post is at http://www.inspire.com/groups/womenheart/discussion/abscess-incision-proble ms-and-osteomyelitis/
p.s. I'm a terrible diabetic--not in control of my numbers and now with being depressed, I'm carbing again.

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C-cat,
Yes, you can drive. Maybe her case is different? She describes the rib discomfort the same way my Dad did. Moving ribs that kind of poke your skin. Once the muscle gets use to it's "new home" in your chest it does firm up and protects your chest quit well. I forgot what it is you do for a living. My Dad was unable to return to his job as a Millwright for General Motors. He was 56. He no longer could climb ladders to steel beams, do welding (due to a pacemaker) or carry heavy machinery. I can't believe they do not have you on antibiotics....especially with your Diabetes. Try, try, try to keep a close check on it! You will only be helping yourself. Hang in there and keep us posted!
Lisa

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C-CAT:

Lisa is quite right. I can only tell you what happened to me. The point is "never surrender". You certainly do have a lot on your plate right now and I truly hope the doctors will put you on antibiotics.

Is carpooling an option for you while things heal? My prayers are with you all the way. You have come so far already. Keep your head up. Depression is a misserable enemy.

Thanks for the web site.

Be blessed --- Gloria ---

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Dear C-Cat,

Make sure you are tested for MRSA.

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Hi. I had sternal reconstruction 1-1/2 years after my bypass. It took a while to convince the docs, but I had fractures all through my sternum and a detached rib. Didn't have a leak, but my scar kept growing longer and wider the last 3 inches, and basically couldn't use my arms for the pain.

They took out the wires first, and that didn't do a thing except cause more pain. So skip that "test" and go straight to the plastic surgery. The surgeon removed my zyphoid process, cleaned everything up, and screwed in two rows of titanium plates across my ribs and sternum. I can't tell you the relief this brought. With everything stable in there, the bone could actually grow together finally. It took longer for the detached rib to heal, but the plates definitely were the answer.

It sounds like you have a more complicated case, but if you have a top-notch plastic surgeon, I think you'll be pleased with the results. Especially if you're a candidate for the titanium plates.

Best wishes. I'll keep following how it goes for you!

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KAKleon:

I've heard about the titaniam plates.
You are the first one I've heard of that actually had it done. More power to you. I am so glad it worked. I wonder if they could do it just across the ribs without the actual sternum to screw it to. That would be wonderful. Let me know what led up to it and how you convinced the docs to go ahead with the procedure.

Gloria

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Hi Gloria. I'm not sure, but that would be great. The surgeon I went to here in D.C., is Haven J. Barlow and he does many sternal reconstructions. I was amazed. Maybe there is an additional "part" that would allow bridging the sternal area.

On x-ray it looks bizarre. Not sure how many cm each plate is, but it makes a chain of plates and screws across.

As for how I got the surgery, it was a long road. No one believed there was a problem. Finally, I was sleeping on the floor of my sons' room when they were sick one night, and had terrible chest pain. The doctor thought it was another SCAD/heart attack, so admitted me. My internist is the one who looked at the chest x-ray and said, "hey, there are fractures all through the sternum." I was so happy to finally have proof! For a year, I'd felt like an anchor was pulling on my collarbone and couldn't really use my right arm for the sternal and rib pain.

The frustrating part was that the cardiologist insisted the first step was taking out the wires and living like that for a while. I didn't get the logic of that. You wouldn't take a cast off a broken leg and expect the person to walk pain free!

So a few months later, I did go see Dr. Barlow and he was just wonderful. I wonder if he could give you the name of a Canadian surgeon?

There are still some things I can't do with my arms and I'm a little bit "torqued" to the right, if you will! Some neck/back pain. But it was a true fix of the sternal pain. I couldn't face a whole life like that.

I truly hope that titanium plates are an option for you (and C-cat). If you get encouraging news, please let me know!

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KAKleon:

WOW !!!!!!!

I just had some chest x-rays taken yesterday and will be having my ultrasound on Friday. I have been having pain in my chest where the sternum should be and we are trying to find out what is causing it. (gallbladder, infection, things moving around and pushing against the ribs, heart or whatever). When all the tests are finished I see the internist on Dec. 1.

I figure if they can repair a fractured sternum with plates and pieces putting it all back together, they should be able to build a complete one and put it in as the bridge between the two sides as it should be.

Please don't laugh at this, but what is a zyphoid process? an actual process, a thing or a name for our zipper looking scar? I've never heard that term before. Thanks for answering so quickly. I'll let you all know what the doc says when I see him.

take care and be blest --- Gloria ---

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C-Cat :

You certainly opened a new book when you posted your request. I certainly wish I could have been more helpful to you. But with KAKleon entering the discussion, I think we will both benefit.

I took a look at the web site you told us about and if that posting were all I was basing my decission on I would be scared spitless. I copied out all 34 pages and read it as well. It covers everything and at the moment everything seems lumped together. I am still wading through it.

Once again, I sorry I couldn't be more help, but please don't give up, your answers are there.

Take care and be blest --- Gloria --

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Xiphoid process definition - Medical Dictionary definitions of ... A pointed cartilage attached to the lower end of the breastbone or sternum, the smallest and lowest division of the sternum. ...

This is an area that could also be my problem as that is where my opening is and some sharp pain as well. The titanium plates certainly look better than the original "erector set" type of metal that was used. I had my cat scan today, so next week I will meet with the surgeon. This discussion is helping with my set of questions for the doc. I'll keep you posted.

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Hi C-Cat and Gloria. I'll be thinking of you both at your upcoming appointments.

Had to laugh about the xiphoid p. The only time I'd heard of it before my surgery was in CPR class! The instructor would have us find it on the Annie doll to do compressions. Apparently, it doesn't do a thing (in humans) -- except cause pain if you've had bypass!

Will stay tuned.
Katherine

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