Sternal wound dehiscence after internal mammary artery harvesting. Logical management.

There is clear evidence that the internal mammary artery is superior to other forms of vascular conduit in surgical coronary revascularisation. Its patency rate at 10 years is of the order of 2-3 times that of autologous saphenous vein. Unfortunately, harvesting of the internal mammary is associated with an increased incidence of sternal wound complications, probably due to temporary sternal devascularisation. The restoration of sternal blood supply has been shown to occur after several weeks. It is proposed by this group that delayed primary closure of dehisced wounds after 3-4 weeks is an effective way of dealing with this malignant and, fortunately, rare complication of arterial coronary artery revascularisation.