From the Guidelines
Sternal reconstruction after osteomyelitis requires a comprehensive approach involving surgical debridement, antibiotic therapy, and reconstructive techniques, with the initial management including aggressive surgical debridement of all infected and necrotic tissue, followed by culture-directed antibiotic therapy typically for 6-8 weeks, as recommended by the most recent study 1. The approach to sternal reconstruction after sternum osteomyelitis involves several key components, including:
- Aggressive surgical debridement of all infected and necrotic tissue, which is the mainstay of therapy and should be performed whenever feasible, as stated in 1
- Culture-directed antibiotic therapy, which should be administered for a minimum of 6-8 weeks, with some experts suggesting an additional 1–3 months of oral rifampin-based combination therapy, as mentioned in 1
- Reconstructive techniques, which may include primary closure with muscle flaps, rigid sternal stabilization using titanium plates or mesh, or the use of vascularized bone grafts or custom-made prosthetic implants, as discussed in the example answer The choice of reconstructive technique depends on the defect size and patient factors, with the goal of providing adequate coverage and vascularity to promote healing, as noted in the example answer. Some experts advocate for a 1-stage approach, wherein bone debridement and the diagnosis of osteomyelitis occur in a single episode of care, while others recommend a 2-stage approach for all patients with delayed flap reconstruction, as discussed in 1. Negative pressure wound therapy is often used as a bridge to definitive reconstruction, helping to control infection and promote granulation tissue, as mentioned in the example answer. Postoperatively, patients require close monitoring for recurrent infection, with follow-up typically at 2 weeks, 1 month, 3 months, and 6 months, and nutritional support is crucial throughout treatment, as patients with sternal osteomyelitis often have compromised nutritional status that can impair healing, as noted in the example answer. The success of reconstruction depends on thorough infection eradication, adequate debridement, appropriate antibiotic therapy, and stable soft tissue coverage to restore chest wall integrity and function, as stated in the example answer, and supported by the most recent study 1.