From the Guidelines
Sternal reconstruction after sternum osteomyelitis should prioritize aggressive surgical debridement of all infected and necrotic tissue, followed by culture-directed antibiotic therapy for at least 8 weeks, as recommended by the Infectious Diseases Society of America 1. The approach to sternal reconstruction involves a multidisciplinary team, including infectious disease specialists, surgeons, and reconstructive specialists.
- Initial management should focus on:
- Surgical debridement and drainage of associated soft-tissue abscesses, which is the mainstay of therapy and should be performed whenever feasible 1
- Culture-directed antibiotic therapy, with options including IV vancomycin, daptomycin, and combination therapies with rifampin, linezolid, or clindamycin 1
- For reconstruction, muscle or myocutaneous flaps are the preferred option, with pectoralis major flaps being the most commonly used due to their proximity and robust blood supply.
- In cases with significant bony defects, titanium plates or mesh may be used for structural support.
- Negative pressure wound therapy is often employed as a bridge to definitive reconstruction or as an adjunct therapy.
- Postoperatively, patients require close monitoring for signs of recurrent infection, with follow-up typically scheduled at 2 weeks, 1 month, 3 months, and 6 months.
- Nutritional support is crucial throughout treatment, with protein supplementation recommended to support wound healing and recovery. The optimal duration of therapy for MRSA osteomyelitis is unknown, but a minimum 8-week course is recommended, with some experts suggesting an additional 1–3 months of oral rifampin-based combination therapy 1.
- Magnetic resonance imaging (MRI) with gadolinium is the imaging modality of choice for detection of early osteomyelitis and associated soft-tissue disease, and erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) level may be helpful to guide response to therapy 1.