Extent-Guided Staged Management of Localized Late-Onset MSSA Sternal Infection after Bilateral Lung Transplantation: A Case Report.

BACKGROUND: Sternal infection after lung transplantation is uncommon but life-threatening; late-onset cases may be difficult to diagnose when signs are subtle. CASE: A 38-year-old female developed methicillin-susceptible Staphylococcus aureus sternal infection with bacteremia 7 months after bilateral lung transplantation. Computed tomography (CT) showed a localized abscess around the sternal wires. MANAGEMENT: CT and intraoperative findings confirmed that infection was confined to extrathoracic peri-sternal tissues without communication with the thoracic cavity. This guided debridement, drainage, wire removal, antimicrobial therapy, and negative-pressure wound therapy (NPWT) with instillation and dwell time followed by standard NPWT. OUTCOME: After infection control and adequate granulation, delayed primary closure was performed 60 days after debridement without flap reconstruction. She was discharged on day 77, without recurrence, 8 months after closure. CONCLUSIONS: Careful assessment of infection extent may help identify patients with localized infection suitable for staged management, permitting delayed primary closure without flap reconstruction.