Post-sternotomy complications

Post-sternotomy complications comprise a varied range of complications that can occur at varying intervals following a median sternotomy. 

Epidemiology

Complication rates for median sternotomy have been reported to range from 0.5-5% and mortality rates ranging from 7-80%.

Pathology

They are perhaps best divided into presternal, sternal and post-sternal compartments:

Presternal

• cellulitis
• sinus tract formation
• presternal abscess formation

Sternal

• sternal osteomyelitis
• sternal dehiscence: malalignment of the sternal wires
• non-union: sternal non-union
• wire fracture
• wire migration

Post-sternal/retrosternal

• infection - inflammation related 
  • mediastinitis
  • regional empyema
  • retrosternal abscess formation
• retrosternal hematoma 

Differential diagnosis

• expected post-surgical appearances: can persist for around 2-3 weeks
  • small foci of mediastinal gas: usually resolve by around 7 days postoperatively but can persist longer
  • defects in the sternum (including of gaps up to 4 mm in width)
  • step-offs (sternal tables at different levels)
  • impaction (overriding of the sternal halves)