TWilliam2019
Guru
I began by making a standard skin incision for a sternotomy and dissected down to the sternum both superiorly and inferiorly around the previous defect and mesh. Next, I dissected out the xiphoid and removed it and gained access under the sternum as much as I was able to and did the same thing superiorly. Next, I then did a sharp excisional debridement of all the infected skin, subcutaneous tissue, fat, muscle, and fascia and dissected it all the way out to healthy appearing tissue and ribs and I performed this circumferentially around the sternum. Next, I then performed a standard redo sternotomy with the oscillating saw. Next, I then dissected the sternum off the underlying pericardium and dissected all the tissue underneath the bone out to the healthy appearing ribs. Again using the oscillating saw I then resected that half of the sternum a partial rib resection of all the attached ribs back to healthy bone and passed it off as a specimen. Next, the same technique was then performed on the opposite side and again passed off to pathology. Next, the wound was then irrigated and hemostasis was achieved. Two 28 Fr chest tubes were placed one in the right pleural space and one in the mediastinum. The case was then turned over to Dr. and the plastic surgery team please his op note for full details.
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