Tuesday, September 02, 2014

Saturday, September 13, 2008 DaddysGirl, Community Member, asks

Q: Removal of sternum after bypass surgery

This is a question for my father.  He is 69 and up until chest pains when he pushed a mower, rode his bike or heaved a bale of hay, he was the picture of health.  He had 4 blockages at 95%, so bypass was our only option.  Here is a short of it:

 

July 11:  Quadruple bypass.  Difficult surgery due to his extraordinarily thick sternum, but good graphs.

 

July 27:  Rush to the hospital with fever, vomiting.  Discover infection in his chest.

 

July 30:  Chest cavity and sternum infected.  Doc cleans but leaves the cavity open so he can go back in to clean out again later.

 

July 31:  In the wee hours, Dad as being moved, or coughed, or sat up (we are unclear as to the exact circumstance).  His heart had already healed from the bypass and connected to the chest wall.  Due to the mobility of the ribs (no sternum), his right ventricle tore 4 1/2 inches.  The nurse reached in (it was open) grabbed his heart and off they went to the heart/lung machine. Nine hours of surgery and 2 patches later, he came out of surgery.  The doc said this trauma had never been survived. 

 

Since he was in induced coma for 3 weeks, he is having to have physical rehab now but will be home in the next week or two.

 

He has nothing in the place of the sternum.  The doc was able to pull up the omentum and flap muscles, but that is it.  I am curious as to how others have gotten along.  Do you need a protective vest?  Will his heart be in danger of tearing again since there is mobility?  Will he have restrictions that will prevent him from lifting, riding or pushing?

 

Thank you to anyone who can help me.

 

 

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Answers (12)
Martin Cane, M.D., Health Pro
9/14/08 10:02am

DaddysGirl,

 

Thanks for your question. 

 

I have had 3 or 4 patients through the years who developed a sternal wound infection, and required the removal of the sternum.  They all had a follow-up procedure in which a flap was placed over the sternum, containing abdominal wall muscle, and sometimes underlying omentum.  This serves to protect the chest cavity from minor contact with people and objects, that most people would encounter in daily living.

 

You may notice that when your father breathes in, his chest/ribs will balloon out a bit, while the flap retracts in a bit.  The opposite occurs when he breathes out.  When lifting heavy objects, people usually take a breath, then hold it and exert heavy pressure by contracting their abdominal muscles.  This should be avoided by your father as this would put extra pressure on the flap. 

 

The walls of the cavity (ribs) will smooth out with time and should not be an issue for another tear.  In addition, the muscles of the flap will help prevent this also. 

 

You will need to discuss all of your questions with the surgeon, especially his future restrictions and precautions.  Wearing a vest for daily activities should not be necessary.

 

You should also know that all of my patients lived for several years, with no further problems related to the removal of their sternums. 

 

Best wishes.

 

Martin Cane, M.D.

Reply
lake lover, Community Member
10/22/09 9:51am

My husband just had his sternum removed and the next morning he coughed and started bleeding.  They had to take him back into surgery and repair a tear on the heart outside muscle area.  He has been in a drug induced "sleep state" since then to allow him to heal.  They said they will "wake him" in about 7 days.  What kind of test do they do to see if he has healed enough?  Also what kinds of activies will he have to avoid from now on. 

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mrbbq82, Community Member
10/23/09 9:19pm

Please see my post below and feel fre to contact me .......I get stronger EVERYDAY it is a slow process

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james, Community Member
1/10/10 7:05am

Hi I am a 41 yr old male that had a massive heart attack in july of 09 rushed to the hospital and into the cath lab the doctor found 12 blockages cleared 6 but then decided to send me for open heart surgery where they did 6 bypasses was in the hospital for about 3 1/2 weeks got out and within a month was back in because the insision had gotten infected they put me on vanco and sent me home with a pic line went to methodist hospital in indianapolis where the did the debreedment then the muscle flap

since being released i get these burning sensations on the oppisite side of the chest is this normal? also I have alot of pain in the middle of my chest and shoulder where they did the flap also since the cabage cannot sleep feels like i am having anxitey attacks will any of this go away?

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ronpaul3, Community Member
1/25/11 9:23pm

I have the same problem as you do. They put me on xanax for the anxiety attacks and zoloft for the depression and just general ill feelings and bad nerves.  I was in the hospital for 6 months on and off for debreedmentand went home with pic line, I was allergic to vanco , so it was really hard to find a drug that I could take.  Thank god I found a good infectious disease doctor because he really saved my life.  The feelings of anxiety still hit me once in a while.  You get afraid to fall asleep because you may not wake up was my biggest problem.I know how you feel.  The burning on the seams of my flap really hurt sometimes.  They have me on hydrocodone7.5 for the pain, but it rally doesn't take it all away. I wish you luck and hope you're lucky enough to get over the anxiety. I slowly am, but you have to take it easy for so long.  It's been months and I still don't have the strength to get up if I happen to sit on the floor.Some day I hope to get a little of my normal life back.

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Teri O'Brien, Community Member
6/23/11 11:48am

My husband had a quadruple bypass done on Nov. 1, 2010 in which he lost his sternum due to a massive staph infection. After 7 surgeries to clean out the chest with the wound vacuum, they finally closed his chest up by bringing up his great omentum muscle & suturing it to his chest. BTW, that was on 12-21-10, when he was discharged from the hospital on 12-25-10, the cardio-thoracic surgeon made a comment to my husband that he didn't quite like the way his chest looked, meaning it was protruding alittle, so he told him to go home and wear a binder around his chest when in fact he was starting to herniate right then and there. Now it has been 6 months & the original surgeon doesn't want to tempt the surgery because it is so HIGH RISK due to the Omentum being very vascular (full of blood vessels). He then referred him to a General Surgeon for an opinion & he said no way, I would need the 1st surgeon there to assist  me. So the 3nd surgeon then referred him to a Plastic Surgeon. The sad part of all of this is my husband's insurance ran out because he was not allowed to return to work due to the herniation. He has alot of discomfort in the check area due to the herniation. What exactly will happen to him without the repair of the herniation? Will it continue to pull away from the abdomen & cause a bowel obstruction? I believe he needs to get an MRI to see the damage in his chest. Is there anyone that can help us. I feel like I am losing my husband everyday. Thank you!   Teri O'Brien,RN

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theduke1943, Community Member
4/13/12 9:56pm

I went through a cabage, quad, and went through pain and eally a bad time for three years, than finally a second surgeon went in to fix what the first had messed up and three days later( after realease) I was back at the hospital with two strians of infection and was told there was little they could do because what I had they had no medication strong enough. Seven weeks with my chest open and in the hospital, twice my family was called in, than a close up where I stopped breathing, family was called back in, I woke up with a ball down my throat and a machine breathing for me, the family was called back in seems I was in a hospital induced coma for a week. Finaly they sent me home under hospice care, the family was notified. Will that was 12 years ago and fishing and grand kids are my hobby.

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mrbbq82, Community Member
4/13/12 10:50pm

Sounds like you have a handle on it .......I am five years out and like you IT IS ALL ABOUT MY GRAND BABIES ....join us on the Sternectomy Support Site

 

GREG

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Sky, Community Member
7/ 3/12 8:41pm

Please tell me more about your problems you had. I had quadruple by pass in September 2011. Now, almost a year later I still have 2 strains of staph infection  and my incision will not heal. I am so afraid. If you feel like it and don't mind sharing please let me know more on how you beat your problem. Thank you for your time... Sky

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mrbbq82, Community Member
7/ 3/12 8:52pm

Sky, I am not sure what I can tell you but I would ask that a full blood culture be conducted and maybe ask if debriment is a consideration

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Sky, Community Member
7/ 3/12 8:55pm

Please let me know how you are doing now. I have some of same problems and I am so afraid. You are very brave....Sky

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mrbbq82, Community Member
7/ 3/12 9:00pm

You can contact me at 519-seven four eight - eleven fifty eight

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mrbbq82, Community Member
1/ 8/09 4:36pm

here are some thoughts

 

http://www.steadyhealth.com/posting.php?mode=quote&p=659330

 

greg AKA mrbbq82

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Karen Lutes, Community Member
2/16/09 8:26pm

I also had a triple bypass surgery in1991 and it got infected within a week.  Back to the hospital for IV antibiotics and debreeding.   I was in the hospital for 4 months.  They took out my sternum, did the muscle flap  and a skin graft as they had debreeded so much it couldn't be closed.  I still have constant pain in my chest and back.  I can not lift more than 5 pounds and I am very caeful about being in crowds.  I can't stand anyone to touch my chest or back.  I carry a pillow in the car to put under the seat belt in front of my chest.  My doctor suggested that.  Hope your father does well,  Karen in Delaware

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Tony, Community Member
5/ 1/09 9:39pm

I can not answer your question because I am in the hospital at this time with my sternum removed and a open chest waiting for the doc to close my chest. they are going to use both of my chest  museals to do what is called adouble pectorial flap. The doc said I would lose the ability to pish an that I had to be careful not to get hit in the chest. I am wondering how painful this operation is going to be. I would not think it could be any more painfil  than it was when the doc took out my sternum. I hope you or someone could tell me how painful this is going to be?

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Carol L., Community Member
4/12/11 12:28am

My aunt, yesterday, had the double pectoral flap closure done on her chest.  I was very worried of the pain that she might be in after the surgery.  Today, all she took was tylenol.  I am very surprised.  She reports little pain.  But then again, this woman has suffered so much with her health and literally tortured each time she would enter the hospital - she is diabetic with heart, lung, and kidney failures.  

 

So think positive, and good luck to you.  God bless you with a long life. 

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islandsun9@myway.coml, Community Member
9/17/09 3:45pm

I to had a quad by-pass in 2001 with complications. After release from hospital i was rushed back to hospital with high fever. It turned out to be an infected sternum that needed to be removed and needed a muscle flap. Unfortunately I have been inj and out of hospitals for severe constant pain. In Feb 09 they removed more of the sterum because of constant pain. Now they want to reopen me once again. with no guarantees to relief the pain. I have been on opiates, patches and morphine for all these years. I know take dilaudid 4mg every 4hrs. If i move the wrong way particularly at night I can feel these torning burning sensations. I have yet to find a doctor who has come up with a plan that will help. So I'm not sure there is a procedure that will return to me to a better life since the removal via muscle flap.

                                                                                        Dennis

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Ken Robinson, Community Member
6/27/10 9:05pm

I had my sternum removed after bypass surgery in 2000 for anurysms  and I was like everyone else , could not live with the constant pain ,duregesic patches ,morphine , pump, just made me crazy ,becoming a zombie , well finally I was almost at the point of sucuide and told the doc. so they got a team of surgeons together and came up with a plan #1 they could shave some more sternum and try and wire it all together it it wouldn't move " so dont move don't hurt (right ) well it is now 20010 and the only problem I didn't forsee was breathing """ you need a sternum to breathe """ I have managed to find a position to sleep where I can breathe ,but have had less pain than the flap way """""

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mrbbq82, Community Member
10/23/09 9:17pm

MY 2007 odessey:

 

May 8 enter hospital short of breath and have an angiogram that shows numerous blockages

May 11 open heart surgery lasting 7 hours and comprising of five bypasses and one valve ring support

May 11 -25 Life support as the Dr's cant awake me and they tell my family that they don't know if i'll ever come out of it

May 26 fourteen days after surgery I wake up

Still unaware of my situation i am weaned from all of my IV's

I am moved to a recovery floor where a groin infection plagues me

I am then moved  to a rehab floor where upon complaining about a sore lower back a surgeon removes a cyst

June 13 my original surgeon looks at my incision and he sticks a finger in it up to his knuckle and then informs me that he is going to have to tiighten a wire holding part of my breast bone in place and so..............

June 16 i am back in surgery to tighten the wires holding my sternum and ribs in tact

I was home in July but dropped in our drive in August

Gee since then i was back in hospital with a massive infection and that resulted in them removing my sternum/breastbone in August again  i was out of it (coma) for 14 days and the family was all gathered but i pulled through and was finally out of hospital mid october

I am still off work (don't know if I even have a job) but it is GREAT to be alive Sealed

I was implanted with an ICD pace/defib in July of 2008 and am part of a study from the Ottawa Heart institute ( RAFT study) I attended a Cardiac rehab exercise pgm and continue at a  a diabetic clinic on a regular basis as well as quarterly visits to a Heart function clinic and cardiac implant clinic ...I was at a Renal clinic today ...our health care system really works when you need it here in Ontario.

I have been in touch with butterly50 and openchestman on another forum both have had radical sternectomy and have given me hope in knowing that I am not alone. If you feel the need I can provide you with more personal contact information for us ( I say us as my wife may be better able to see it from your side) I will provide you with email info and from there we can send phone numbers...I think Sharon would be great to talk to as she was there all along doing the hard work while i slept LOL

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DAttack, Community Member
12/17/10 8:36pm

I noticed that you are willing to discuss this condition.  A friend of mine just had his breastbone removed today and they are discussing the flap surgery in about 5 days.  He has no ideal what is going on as he has been unconscious ever since the triple bypass that he went in for.  My sister has medical POA and isunsure what options are open to our friend.  Any help would be appricated. 

Thanks, Don and Deddie

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theduke1943, Community Member
4/14/12 3:24am

The sternum is not a bone. Cartledge is what it is and is allot more fleable than bone. A tempary hard shell external cover like a turtle shell helped me allot at first.

He should keep in mind the fragile condition and remind himself that air bags in cars are very bad,

Light at the end of the tunnel is it is slow to recover(In My Case) after 12 years things are workable, the pain due to over stressing two single muscles in the chest that are not tied together, instead of one as was intended.

One of my co-workers was back running a cat for a road crew in about 3 months.

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Anthony, Community Member
11/ 8/09 2:23am

Hello my name is Anthony Nelson (56 years old) and I live in Cope SC. Your dad and I have just about the same medical problems. I just got out of the hospital after spending 5 months and 3 major operations later. I had my sternum remove due to infection and major problems with the mobility of my ribs. Every time I turn around it is like I have broken a rib then it takes a couple of weeks to get better and then I turn around and have the something but on a different rib. This has happened several times to me.

 

The doctors told me that due to all of my other medical problems such as diabetes, factor five Leiden gene mutation, COPD, hepatitis B, Sarcoid of my lungs, anemic, DVT's with multiple blood clots in both legs, past amputation of my right leg, 2 times I have broken the femur in my right leg two different times and just about in the same location just above my right knee, I have had chronic pain in both legs after having all of the blood clots and breaking of my femur, 

 

PTSD major depression with anxiety disorder just to list a few things more about my heath, and multiple ulcers on my left leg and have lost a lot of the feeling in my left leg due to diabetic neuropathy with all of the extras like pain and ulcers, hammer toes and this is not all the other medical problems I haven't listed. 

The doctors left me with my chest wide open for a long time until they felt the infection had cleared enough to perform a dual pectoral flap. This was to help fill in the large hole in my chest. No one has told me about being able to tear a hole in my heart because of my ribs being able to move. The doctors finally told me that I would not be able to do a lot of the things I use to do because of free floating ribs. All of this started after having two heart attacks and two congestive heart failures as well as telling me that the two main arteries one of them 70% blocked and the other one 100% blocked. The doctors told me that I would not make it off of the operating table if they operated.

 

It is bad when you're going to die if you do or die if you don't  and then that last moment after being place on a operating table waiting for the moment of dozing off and knowing your chances were nil to none. I surprised the whole hospital by making thru the operation. I will never forget the moment when I came to and opened my eyes. I guess I have run my mouth enough for now.

Please tell me how your dad tore a hole in his heart so that I could avoid that happening to me. I will tell you this if it had not been for GOD I would not be here now. Keep in touch. You know I need the same things your dad needs like some type of protection over chest to keep from getting hit or falling and hitting something on the way down I also need to know how to perform heart resuscitation without a sternum I would not want to die because of CPR so I think someone should tell us how it is done so that family members knew what to do.

  

Anthony Nelson

 awnelson@hughes.net

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aliveandwell, Community Member
11/ 9/09 11:30pm

I had a sternum/ribs infection 6 weeks after my open heart surgery.  I was in the hospital for 28 days intensive care with infection.  I had debrevement every Monday for 3 weeks.  Due to the fact I am a woman they removed my sternum and filled it up with breast material.  I am still alive after 3 years and intend to live many more years. I just have a problem finding a comfortable bra with easy support.Cool

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Wanda, Community Member
6/ 7/11 10:05pm

I to had this problem until I went to Macy's and the woman helped so much on getting the right fit. Great to wear a bra after 9 months.

 

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meg, Community Member
1/18/10 2:24pm

this is similiar to something i have been struggling with for a long time. my grandpa had the 6 bypass, 1/3 of his heart died, his sternum was infected and died as well..he was in the hospital for about 2 months, on the vent. it was awful and i assumed over time things would get better..it just seems to me nothing has changed. and i dont know where to go for answers. he can barely walk..or do anything! and its been about 7 months. he does rehab 2 times a week and has since he has been home. has has your dad been getting along since he has been home?

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mrbbq82, Community Member
5/17/10 8:44pm

there is an online support group that may be of help

 

http://sternectomysupport.webs.com

 

greg

 

 

,

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Dr Ron Hestand, Community Member
10/16/10 1:42pm

I had a tripple cabbage a year ago on the 26th. A few days later they noticed abnormal drainage along the suture line. They cultured it and it came back MRSA. I was taken back to the OR and had a radical sternectomy. Because of numerous abdominal surgeries, they had to use a pectoral flap rather than an abdominal one. I was on Vanco for 3 months and had several pic lines. The Vanco disrupted my systems, and my kidney's shut almost completely down. Since I was on Medicare, they wouldn't pay for the Vanco at home, but only in a nursing home. I elected to go home rather than a nursing home (this was before the Vanco threw my systems off). It took every bit of our savings and available credit to pay for the Vanco at home. I was also on a wound vac because the chest wall didn't heal right, and I have a hole in my chest wall now. My pecs and shoulder muscles hurt constantly. I can't lift things over 5 lbs, or do the things I used to. It feels like there is a steel band around my chest when I try to breath deeply. My VA primary care provider suggested that I wear a sports bra when I asked about a chest protector since I am paranoid about getting hit in the chest or falling. We are waiting to see if the VA will come up with something for me. In the mean time, the wife has ordered me a paint ball chest protector.

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Survivor, Community Member
11/24/10 4:50am

Hello, I see you have suffered as much as I because of heart surgery. I had an aortic valve replacement in October 2009. All went normal until they thought I had loosened the sternum wires. Back to OR, where they reinforced them. I suffered blood loss and needed more blood, was so weak it took 3 weeks to be able to walk so I could go home. I was home almost 2 weeks and developed the dreaded sternum infection. Admitted to hospital immediatly, they removed the wires and did debreedment. My chest was open for 4 days to clean it and then had the dual pectoral mucsle flap. What pain! Again it was nearly a week before I could again walk at all. I went home after 12 days and like you say, so much pain! So much depression and feeling like I was all alone! It is now Nov 2010 and I have pain in my chest when I bend to pick up something, cough really hard, and like you, afraid of someone or something hitting my in the chest. The feeling of steel band thing subsides, but I had a hole in my chest that finally the dr sent me to a wound specialist and they cleared it up with silver strips. It's just been about 5 months since that healed up. This has been such a painful ordeal, but I feel fortunate to be here still. Hope yours heals and you can put it behind you also. That chest protector sounds like a good idea too. Good Luck and God bless you.

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ronpaul3, Community Member
1/ 5/11 6:42pm

I had a double by pass went home all was fine.Kept having severe chest pains. Went to doctor and where my air tubes was draining. He told his nurse to put bandaids on them.  2 days later my chest exploded litterally.  I had a massive infection which turned out to be staph and mrsa.Had my sternum removed right collar bone and three ribs trimmed back.  Was in the hospital 3 days short of six months.  On a wound vac machine. Had 7 plastic surgeries.  They took my belly fat and turned it around and put it where my sternum was supposed to be.  After 9 months it's still store and I can't lay flat to sleep or on my side.  Worst pain ever in my life.  My heart didn't tear or anything like that, but when I was on the wound vac when they changed the dressing you could see the top of my heart.  very scary thing.  They put in as titanium plate to draw my ribs back together, but my bones were too infected and weak and it had to be removed. I wish your fater luck because I know sometimes you'd rather have died than to have to live like this.

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Donald Reel, Community Member
9/19/11 11:40pm

Hello: My husband had a by-pass surgery in aug 2010 wires broke in the hospital found out later in the transcript that Kaiser had taken a xray and had known that 2 out of the 3 wire had already broken but didn't go in and repair . Like yourself his chest exploded.  Took him back to rewire but after 2 weeks home developed staph infection.Hospital used gauge to suck up the infection rather than a wound vac. A few days later Kaiser Permannent removed his sterum and cut back most of his ribs.Surgerical cut under his armpit surgerical performed a pitoral flap. Kept him in a medical induced coma for 4-5 days until I insisted they take him off it due to pheumonia complications. By this time I was terrified of this hospital and the family talked him into being treated at the Veterans Hospital at Palo Alto in California. God Bless them. Not only did they dieafed(not sure I'm spelling this word correctly) him and cut back more ribs due to more infection. But found that Kaiser hadn't treated him for 2 fungus infections. Can you believe that! Now we're facing a hernia mesh operation. Please email us back. It's made a difference to my husband knowing he's not the only person that's been through this horrible ordeal. Our names  Don & Linda Reel   email: bellarose0983@yahoo.com   or only1me999@yahoo.com. Please contact us.  

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Donald Reel, Community Member
9/19/11 11:40pm

Hello: My husband had a by-pass surgery in aug 2010 wires broke in the hospital found out later in the transcript that Kaiser had taken a xray and had known that 2 out of the 3 wire had already broken but didn't go in and repair . Like yourself his chest exploded.  Took him back to rewire but after 2 weeks home developed staph infection.Hospital used gauge to suck up the infection rather than a wound vac. A few days later Kaiser Permannent removed his sterum and cut back most of his ribs.Surgerical cut under his armpit surgerical performed a pitoral flap. Kept him in a medical induced coma for 4-5 days until I insisted they take him off it due to pheumonia complications. By this time I was terrified of this hospital and the family talked him into being treated at the Veterans Hospital at Palo Alto in California. God Bless them. Not only did they dieafed(not sure I'm spelling this word correctly) him and cut back more ribs due to more infection. But found that Kaiser hadn't treated him for 2 fungus infections. Can you believe that! Now we're facing a hernia mesh operation. Please email us back. It's made a difference to my husband knowing he's not the only person that's been through this horrible ordeal. Our names  Don & Linda Reel   email: bellarose0983@yahoo.com   or only1me999@yahoo.com. Please contact us.  

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theduke1943, Community Member
4/13/12 9:44pm

I have lived 12 years with out a sternum or protection. At first I had an exterior sheild made just for protection, even had a shulder peice added since it was near hunting season and I wanted to hunt with a rifle. The shield fit over my chest like a bullet proof vest but much straonger support. After 2 years the healing was good enough to go part time with out the shield. Now I no longer use it. For the first year or so I would suggest riding in the back seat of a car, the air bag alone would be to much pressure and the seat belt will pull his shoulders apart if an accident happens.

I due live with muscles pain of my chest and swelling every time I over use my muscles. I do not left bails or use a pick and shovel, things I never thought I wouls miss at retirement. Fishing time has increased, time with my lovely wife has increased and the grand kids are great, once they understood what to be careful for and more time with them is good for any soil.

Bottom line onme has pain but also has possitives that far out wiegh the pain.

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mrbbq82, Community Member
4/13/12 10:55pm

I wear a sport sternum compresion shirt daily

http://www.mcdavidusa.com/store/item.asp?ITEM_ID=522&DEPARTMENT_ID=707

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theduke1943, Community Member
4/14/12 3:17am

careful pnuemonia has been a side effect in some reports due to breathing not being free.

I lost 40% capacity with the removal which is normal since we no longer have those muscles to help us breath.

May be deferent now, mine was done when I was the 6th one done in this hospital and they had very little expierance.

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By DaddysGirl, Community Member— Last Modified: 03/17/14, First Published: 09/13/08