Chest and Leg Wound Complications : The patients under going CABG are usually elderly, obese and nearly a quater of them are diabetic. So sonic of them get superficial or deep chest wound infections and more seriously internal dehiscence. The incidence of sternal breakdown is higher if bilateral internal mammary artifices ale harvested for grafting. It is better to avoid wound problems with meticulous aseptic precautions, careful haemostasis and accurate closure of wounds in layers.
Deep wound infection in the chest can lead to sternal dehiscence and mediastinitis. This may lead to blockage of grafts and secondly haemorrhage, which can be fatal. After the second post-operative day, wound is inspected daily for redness, edema and tenderness. Stability of the sternum is regularly checked. Pus collection is evacuated early and if sternum is unstable, urgent surgery is indicated. IT sternal edges are not too badly infected, resuturing of sternum is done after debridement. Post-operatively, some patient's arc fitted with a chest corset to prevent excessive movement of sternal edges on coughing. In cases of badly infected sternum, the edges are freshened by excision and extensive debridelnent done. Either primary closure of the sternam, a pectoral myoplasty or rectus abdominus myocutnncous flap repair is to be adopted.