Name of the Procedure:

Sternal Debridement

Summary

Sternal debridement is a surgical procedure to remove infected, damaged, or dead tissue from the sternum (breastbone). It aims to clean the area to promote healing, prevent spread of infection, and prepare the site for further reconstruction if needed.

Purpose

Sternal debridement addresses infections of the sternum, often following cardiac surgery. The goals are to remove infected tissue, decrease bacterial load, and promote healing of the sternum and surrounding tissues. It can also prepare the area for possible reconstruction or further surgical interventions.

Indications

• Postoperative sternal wound infections
• Osteomyelitis (bone infection) of the sternum
• Presence of necrotic (dead) tissue impeding healing
• Non-healing sternal wounds despite conservative treatment

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments to medications, particularly blood thinners, as directed by the healthcare provider.
• Pre-procedure diagnostic tests such as blood work, imaging studies (e.g., CT scan), and possibly wound cultures.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the sternum to expose the infected or necrotic area.
3. Specialized surgical instruments are used to remove the infected, damaged, or dead tissue.
4. The area is irrigated with sterile solutions to clean out any residual debris or bacteria.
5. Antibiotic-soaked materials may be placed in the wound to aid in infection control.
6. The incision is closed, often using techniques that facilitate drainage and prevent fluid buildup.
7. In some cases, a vacuum-assisted closure (VAC) device may be applied to enhance healing.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the infection and the amount of tissue that needs to be debrided.

Setting

Sternal debridement is performed in a hospital operating room, often in a specialized unit for cardiac or thoracic surgery.

Personnel

• Cardiothoracic surgeon or a general surgeon with experience in thoracic procedures
• Anesthesiologist
• Scrub nurse and circulating nurse
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding tissues or structures (e.g., heart, lungs)
• Chronic pain or discomfort
• Poor wound healing or need for additional surgeries

Benefits

• Removal of infected or necrotic tissue, reducing the risk of further infection.
• Enhanced wound healing through a cleaner and healthier tissue environment.
• Potentially preventing more serious complications such as sepsis.

Recovery

• Postoperative care includes wound monitoring, dressing changes, and possibly the use of a VAC device.
• Antibiotics may be administered to prevent or treat infection.
• Patients are typically advised to avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments are essential to monitor healing and address any complications.

Alternatives

• Conservative treatment options such as antibiotic therapy and wound dressing changes.
• Hyperbaric oxygen therapy to enhance wound healing.
• Other surgical options like flap reconstruction if a large amount of tissue is lost.

Patient Experience

• During the procedure: As the patient will be under general anesthesia, they will not feel or remember the procedure.
• After the procedure: Patients may experience discomfort or pain, managed with prescribed pain medication. They might also feel fatigue and require assistance with daily activities during the initial recovery period. Comfort measures and proper wound care are critical to ensure a smooth recovery.