2023 Volume 37 Issue 5 Pages 479-485
A 78-year-old woman fell and presented to her previous doctor with chief complaints of an abrasion on her left arm, posterior neck pain, and anterior chest pain.
She was transferred to our department for further evaluation and treatment, diagnosed with cellulitis of the left arm, Th2-3 spondylolisthesis, sternum body fracture, sternal osteomyelitis with a chest wall abscess, an anterior mediastinal abscess, and right-sided pleural empyema caused by methicillin-susceptible Staphylococcus aureus infection. Surgical debridement including resection of the infected sternum body and pleural curettage and lavage with video-assisted thoracic surgery were performed. The sternal body defect was managed by negative-pressure wound therapy with instillation and dwelling (NPWTid) following debridement. Reconstruction of the chest wall with the pedicled rib-latissimus dorsi (RLD) osteo-muscle flap was performed in the 2nd-stage operation. She showed an uneventful postoperative course, and was discharged home on the 39th day after admission. This case suggests that reconstruction with a pedicled RLD osteo-muscle flap and NPWTid are useful options for sternal osteomyelitis and mediastinitis.
