Retained Foreign Bodies, The Cause of Postmidsternotomy Sinuses: Case Reports

Postmidsternotomy chronic si nuses have received little attention in the literature. They are usually not a life-threatening complication but may sometimes lead to grave condi tions such as acute mediastinitis, in fection of prosthetic valves or vascu lar grafts, and sternal osteomyelitis. Most patients suffering from this problem usually undergo several un successful surgical interventions ow ing to failure to recognize the under lying cause in the first place. The cause of the sinus is nearly always a foreign body situated deep within the tissues from the time of the original operation. The authors believe that it is of utmost importance that the ex tent of the sinus be demonstrated prior to surgery by sinogram or other imaging techniques. Unless the for eign object is identified and removed, the sinus will recur. Over the last four years, they treated 70 patients with postmid sternotomy complications; 14 of them had sternal sinuses. In each of the 14, some grade of wound infection oc curred at the immediate postopera tive period following the original op eration. In all cases, a foreign body was identified prior to or during ex ploration and removed. These in cluded wires, pacemaker electrodes, silk sutures, a Teflon pledget, and a piece of steridrape. Follow-up, rang ing up to twenty-seven months, shows no recurrence of the sinuses.