How do you treat sternal dehiscence? A guide to surgical and non-surgical options

October 2, 2025 •

4 min read

Affecting up to 5% of sternotomy patients, sternal dehiscence can be a serious complication that causes significant morbidity and can even be life-threatening. Understanding how do you treat sternal dehiscence is critical for patients and caregivers to ensure proper management and recovery.

Quick Summary

Treatment for sternal dehiscence is a complex, often multi-stage process involving aggressive infection management, surgical debridement, and robust reconstruction, with non-surgical options used in certain cases, especially for mild or superficial issues. A team of specialists determines the best approach based on the severity and presence of infection.

Key Points

Initial Assessment: A thorough physical exam and imaging studies like X-rays or CT scans are crucial for confirming sternal dehiscence and determining its severity.
Infection Management: Aggressive antibiotic therapy, guided by wound cultures, is a primary component of treatment, especially when deep sternal wound infection is present.
Surgical Debridement: Removing all necrotic and infected tissue is a mandatory first step before any reconstructive efforts can begin.
Surgical Repair Options: Depending on bone quality, surgeons may use new wires for re-closure, rigid plate fixation, or perform muscle or omental flap reconstruction.
Supportive Measures: Postoperative care involves supportive external vests, negative pressure wound therapy (NPWT) to aid healing, and controlling underlying health issues like diabetes.
Recovery and Prognosis: Treatment often involves a prolonged hospital stay and rehabilitation, but can lead to a stable chest wall and resolution of infection with proper care.

Understanding Sternal Dehiscence

Sternal dehiscence is the partial or complete separation of the sternum (breastbone) following a median sternotomy, a surgical procedure commonly used in open-heart surgery. This condition can lead to significant pain, sternal instability, and, in severe cases, life-threatening infections like mediastinitis. The therapeutic approach is highly individualized and is determined by the extent of the separation, the presence of infection, and the patient's overall health.

The Critical Role of Accurate Diagnosis

Early diagnosis is paramount for effective treatment. Doctors use several methods to confirm sternal dehiscence:

Physical Examination: A medical professional can often identify a 'clicking' or 'rocking' sensation of the sternum, particularly when the patient coughs or moves. They may also check for visible separation of the wound edges, tenderness, or unusual drainage.
Radiography: A simple chest X-ray can reveal signs of sternal separation, such as shifting wires or a midline lucency. While a basic tool, trained eyes can spot subtle signs and prevent the condition from worsening.
Computed Tomography (CT): For deeper, more complex infections, a CT scan provides detailed imaging of the sternum, mediastinum, and surrounding tissues, helping to confirm the diagnosis and assess the extent of infection.

Conservative and Non-Surgical Treatments

In some less severe cases, particularly involving superficial dehiscence without deep infection, a conservative approach might be considered. This focuses on managing symptoms and promoting natural healing. However, surgical intervention is often necessary for significant instability or infection.

Wound Care and Management

For superficial wounds, consistent and meticulous care is crucial to prevent infection and promote healing by secondary intention, where the wound heals naturally from the inside out.

Regular Cleaning: The wound must be regularly cleaned with sterile saline to remove debris and dead tissue.
Packing and Dressing: The wound is packed with a dressing to absorb exudate and protect the site.
External Support: A chest harness or vest can be used to stabilize the chest and reduce sternal motion, though patient compliance can be an issue.

Negative-Pressure Wound Therapy (NPWT)

NPWT is a highly effective non-surgical option that can act as a bridge to surgical closure. After initial debridement, a vacuum pump is attached to a sealed dressing over the wound. This therapy offers several benefits:

Increases Blood Flow: Promotes circulation to the wound area, which aids healing.
Removes Fluid: Sucks excess fluid from the wound bed, reducing bacterial load.
Stabilizes the Sternal Edges: The negative pressure provides some stabilization, which can reduce patient discomfort.

Surgical Re-intervention

Surgical repair is the gold standard for treating deep sternal dehiscence, especially when accompanied by deep sternal wound infection (DSWI) or mediastinitis. This process is often a multi-step procedure:

Debridement and Wire Removal

The first step involves reopening the wound to thoroughly clean the area. This includes:

Removal of Old Wires: The original sternal wires are removed to eliminate any source of infection.
Necrotic Tissue Removal: All dead or infected tissue is surgically removed to create a clean wound bed.
Wound Irrigation: The surgical site is flushed with a saline solution to further cleanse the area.

Sternal Reconstruction and Stabilization

Once the infection is controlled, the sternum must be re-stabilized. Surgical techniques vary depending on the sternal bone quality.

Rewiring: In cases where bone quality is still adequate, the sternum is re-approximated with new, often reinforced, steel wires.
Plating Systems: For weakened or fragmented bone, rigid plate fixation systems (e.g., titanium) are a robust alternative, providing enhanced stability and minimizing motion.
Muscle or Omental Flaps: When the sternum is severely damaged or there is a large defect, plastic and reconstructive surgery techniques using muscle or omental flaps are used to fill the space and provide healthy, well-vascularized tissue. Common flaps include the pectoralis major and rectus abdominis.

Comparing Surgical Treatment Options


Feature	Rewiring	Plating Systems	Muscle Flaps	Omental Flap
Sternal Stability	Moderate (bone-dependent)	High	Can restore stability	Does not provide stability
Infection Control	May be limited	Effective when combined with debridement	Excellent blood supply aids infection fight	Excellent blood supply, fights infection effectively
Invasiveness	Re-operation; less invasive than flaps	Re-operation; hardware implantation	More invasive; requires donor site	Highly invasive; requires laparotomy
Bone Quality Required	Good to moderate	Can be used for weakened or fractured bone	Poor bone quality is acceptable	Fills defects regardless of bone state
Best for	Non-infectious dehiscence; good bone	Complicated or high-risk cases	Extensive sternal defects	Salvage cases, large defects

The Healing and Recovery Process

Recovery from sternal dehiscence treatment can be lengthy and requires a dedicated, multidisciplinary approach involving surgeons, infectious disease specialists, and nurses.

Antibiotics: Systemic, culture-directed antibiotics are a mainstay of treatment, often for an extended period of 6 weeks or more, especially with a history of infection.
Hyperbaric Oxygen Therapy: This promising adjunct therapy can enhance the body's ability to fight infection and accelerate tissue repair, though it is not widely used.
Nutritional Support: A focus on good nutrition is critical, as conditions like malnutrition and diabetes are major risk factors for poor wound healing.
Rehabilitation: Physical therapy and respiratory support are key to help patients regain strength and lung function.

Conclusion

Effectively addressing sternal dehiscence requires a meticulous approach, beginning with prompt diagnosis and continuing through aggressive infection control and stable reconstruction. While mild cases might respond to conservative measures, most require re-operation with debridement and robust fixation or flap reconstruction. Adherence to post-operative instructions, including rehabilitation and management of underlying health conditions, is essential for a successful outcome and preventing recurrence. This complex condition underscores the importance of a comprehensive, expert medical team. For further authoritative information, you may consult resources like the Cleveland Clinic's health library on wound dehiscence [https://my.clevelandclinic.org/health/diseases/wound-dehiscence].

Frequently Asked Questions

Sternal dehiscence is most often a complication following a median sternotomy, a surgical procedure where the breastbone is divided. It can be caused by infection, poor bone quality, or excessive stress on the surgical site from coughing or movement.

Common symptoms include chest pain, a 'clicking' or 'rocking' sensation in the sternum with movement, and visible separation of the wound. If infection is present, there might be fever, purulent drainage, and increased wound warmth or redness.

For superficial dehiscence without deep infection, conservative measures like wound care, dressings, and external support might be sufficient. However, significant instability or deep infection almost always requires surgical intervention for successful healing.

NPWT is a technique that uses a vacuum pump connected to a special dressing placed over the wound. It helps clean the wound by removing excess fluid, increases blood flow, and can be used as a temporary measure before reconstructive surgery.

Muscle flaps, often from the pectoralis muscles, are used in cases of severe damage or infection where the bone cannot be re-approximated. The flaps fill the wound cavity with healthy, well-vascularized tissue to eradicate infection and promote healing.

Recovery can vary significantly based on the severity of the dehiscence and the treatment required. It may involve a lengthy hospital stay for surgical repair and antibiotic therapy, followed by a period of rehabilitation and strict activity restrictions.

Risk factors include advanced age, obesity, diabetes, osteoporosis, smoking, and chronic lung disease, which can impair wound and bone healing. The use of bilateral internal mammary arteries during bypass surgery also increases risk.