Gur et al developed a staging system for sternal wound infection using clinical findings and changes seen by computerized tomography (CT) or other imaging technique. The stage was important in determining the optimum therapy for the patient. The authors are from Tel Aviv University in Israel.
Clinical and Radiologic Findings
Stage
presternal soft tissue infection
I
sinus tract to foreign body
II
involvement of external plate or sinus to sternal medulla
III
involvement of internal plate or signs of infection in paramedian incision
IVa
costochondral infection
IVb
mediastinal infection
V
after Table IV, page 352
Reconstruction options:
(1) primary closure
(2) secondary healing
(3) local skin/muscle flap
(4) bilateral pectoralis major muscle advancement
(5) unilateral pectoralis major and/or rectus abdominis turnover
(6) omental flap
(7) pectoralis major muscle flap
(8) rectus abdominis muscle flap
Stage
Therapy
Reconstruction
I
conservative treatment or soft tissue debridement
1, 2 or 3
II
sinusectomy and foreign body removal
1, 2 or 3
III
resection of sternal external plate
4 and/or 5
IVa
semitotal or total sternectomy
4 and/or 5 and/or 6
IVb
resection of ribs or clavicle
1 or 7
V
debridement and irrigation
6 and/or 7 and/or 8
after Table IV, page 352
where:
• A semitotal sternectomy is resection of the smaller hemisternum resulting from the paramedian incision.
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