الفهرس 
Clinical PictureOnly 14 pages are availabe for public view
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Abstract
Median sternotomy is the gold standard incision in open heart surgery. One of its most serious complication is sternal wound infection and dehiscence. The incidence of this complication was known to be about 0.15 -20%, although recent work shows that it is reduced to 2% but when this complication occurs , there is significant morbidity and mortality rate which exceeds 20%.
There are different methods of classifying types of sternal wound infection and dehiscence but they are all about whether it is superficial infection affecting the skin and subcutaneous tissue or deep wound infection affecting the sternum and mediastinum.
Many studies have been carried out to identify risk factors which can be categorized as medical causes such as obesity, COPD, DM and operative causes such as surgical technique, antiseptic preparations, antibiotic and the use of internal mammary arteries . Unfortunately only few of these are modifiable.
Early diagnosis and proper treatment is the key point in this serious problem. It depends mainly on high index of suspicion and daily examination. Although there are some investigations which might help in the diagnosis, but they are far less evident than clinical diagnosis.
As the sternal wound infection is a major complication many studies were done to find methods of prophylaxis concerned mainly with aseptic conditions, antibiotic prophylaxis, optimizing conditions of wound healing and the surgical technique especially those concerned with rigid bone fixation.
Surgical treatment is mandatory in most cases with early aggressive debridement in all cases, where some claims that open treatment and late closure is successful, while most surgeons adopt the theory that primary muscle or omental flap may achieve earlier and better results.
Recently, reconstruction using variable tissue flaps to obliterate dead space and provide immediate coverage of the thoracic contents, showed very high success rate. The omentum, pectoralis major, rectus abdominis and latissimus drsi muscle have been the most commonly used tissue flaps.
Lastly, The vacuum assisted closure provides a variable and efficacious adjunctive method by method by which to treat postoperative wound infection after cardiac surgery. It is especially useful for managing sternal osteomyelitis in high risk patients and is an attractive option as a first line therapy followed by closure with wires or plates or combined with muscles and omental flaps
The post operative care is an important issue not to be neglected , as these patients are usually high risk patients and has been debelited from this complications. It has an important role I preventing morbidities afterwards.