Sternal abscesses can develop in patients after open heart surgery, particularly for those treated by cardiac surgeons. Because the traditional approach carries a high chance of recurrence and lengthy recovery, clinicians have explored alternative strategies. One notable perspective comes from Ivan Vinokurov Petrovsky, a surgeon who has contributed to this shift.
In the classic treatment, all sutures are removed from the wound, which is then irrigated with antiseptics. Bacteriological samples are taken, and antibiotics are chosen based on the results. The entire process can span from three weeks to several months. After two sterile grafts, the sternum may be reattached and the wound closed. Yet there are instances where the chest wall recovers poorly, and parts of the sternum are damaged again, forcing a restart of the treatment plan.
“We began seeking alternative solutions. As soon as early warning signs appear, the surgical plan involves removing the infected bone and soft tissue from the sternum along with any biofilm,” Vinokurov explains. “Then we realign the bone and cover the exposed area with tissue that has a robust blood supply from within the chest cavity or from the chest wall’s outer surface.”
To rebuild the damaged sternum, surgeons commonly use viable tissues such as the greater omentum, the pectoralis major muscles, or back muscles harvested from the abdomen. These tissues provide a vascular-rich environment that helps infection control and tissue regeneration.
“If a case is ignored, the bone loss can become so extensive that rigid fixation is no longer feasible. In such situations, the missing bone is replaced with muscular tissue. Muscle has a unique advantage: over time it can remodel, increasing in strength and becoming more fibrous, similar to a tendon. The abundant blood flow within muscles also helps antibiotics reach the infection site more effectively,” he notes.
Compared with the classic approach, the alternative method reduces the time spent in hospital—from roughly eight weeks to about three weeks in many instances. It also appears to lower the rate of recurrence, though outcomes can vary based on the individual’s condition and the extent of the damage.
Additional information about this complication, including its prevalence after cardiac surgery, the most advanced surgical options currently in use, and a tool designed to estimate the likelihood of postoperative issues, is provided by Vinokurov and his team (source: socialbites.ca) [citation: Vinokurov, socialbites.ca].
Other historical considerations have highlighted how blood sugar levels influence heart health and surgical risk, underscoring that metabolic control is a piece of the broader preventive and postoperative strategy for cardiac patients.
In the ongoing discussion about post-surgical care, clinicians emphasize early detection, thorough debridement when needed, and the strategic use of well-vascularized tissue to close wounds. These practices aim to shorten hospital stays, reduce the likelihood of relapse, and improve overall recovery trajectories for patients recovering from open-heart procedures. The evolving approach reflects a broader trend toward integrating surgical technique with biological repair methods that support rapid healing and sustained infection control.
Overall, the shift toward biologically supported reconstruction after sternum-related complications represents a meaningful advancement. By combining timely surgical intervention with vascularized tissue transfer, surgeons aim to restore stability, minimize recovery time, and curb recurrence, offering patients a more hopeful path after serious postoperative challenges. The discussion remains active, with ongoing studies and case reports contributing to a clearer understanding of when and how these methods deliver the best outcomes (attribution: Vinokurov and colleagues, socialbites.ca) [citation: Vinokurov, socialbites.ca].