gms | German Medical Science

Objective: Vacuum assisted closure technique is widely used in wound infection control. In deep sternal wound infections (DSWI) after e.g. cardiac surgery there are several beneficial effects, nevertheless occurrence of severe side effects may be deleterious. Whereas bleeding complications are widely reported, we describe an unusual case of a sternal tumour.

Methods: A 72-year-old male was operated on for coronary bypass grafting in 2006. Beside his coronary artery disease he had significant morbidity: peripheral arteriosclerosis with lower limb amputation, carotid stenosis, diabetes, liver cirrhosis, COPD, low frailty score (Katz Score 4). Postoperatively, he developed a DSWI which was treated with a long term vacuum assisted closure therapy, and finally, a secondary wound closure could be achieved after a period of 22 months.

Results: In 2012 he noticed a small tumour (2 cm) on the upper third of the sternal scar. After 2 months the tumour was enlarged and a biopsy was performed which has shown unspecific metaplastic cells as well as leucocytes and pus. Thereafter, he was referred to our centre and a CT-Scan was performed. A large tumorous process was revealed (Figure 1 [Fig. 1]). Bypass graft and the left internal mammary were involved without relevant stenosis. A second sternal biopsy was performed a squamous cell tumour was diagnosed, besides a slight positive microbial finding (staphylococcus haemolyticus). In our interdisciplinary thoracic tumour board radiotherapy was indicated, because of impossibility of surgical resection. Initially, tumour progress was control, but the patient died 6 months later.

Conclusion: We hypothesize, that this uncommon site of a squamous cell tumour has been induced by the long term vacuum assisted closure therapy. In our knowledge this is the first described case. Because of the increasing use of vacuum assisted closure therapy, especially in the management of DSWI, long term control of patients is indicated.