The danger in skin grafting the bare mediastinum after sternectomy for postcoronary bypass dehiscence

We describe a patient who underwent coronary bypass grafting, after which severe mediastinitis and sternal osteomyelitis occurred. Repair after sternectomy was undertaken with a rectus-abdominis myocutaneous flap. The distal fifth of the flap underwent necrosis and was replaced by a meshed split-thickness skin graft. A year later, a clip marking one of the bypass grafts nearly eroded through the skin graft, endangering the bypass graft. The skin graft was removed by abrasion, and the bypass graft was covered with a pectoralis muscle flap. We recommend that skin grafting of a granulating wound over coronary artery bypass grafts be avoided if possible.