Introduction
After open-heart surgery through the breastbone (sternotomy), the breastbone is closed with steel wires and the skin with stitches or glue. The wound and the bone need weeks to heal.
Good wound care and sensible activity help the wound heal, lower the risk of infection and protect the breastbone while it knits together.
Why the procedure is needed
Sternal wound problems are uncommon but serious, so patients are taught to look after the wound and watch for:
- Redness, warmth, swelling or pain that is getting worse
- Discharge, pus or a bad smell from the wound
- Fever or feeling unwell
- A clicking or moving feeling in the breastbone, or the wound opening
- Higher risk in people with diabetes, obesity, smoking, long operations or poor nutrition
Who may benefit
- All patients who have had a sternotomy, for bypass, valve, congenital or other heart surgery
- Patients with higher risk of wound problems, such as those with diabetes, obesity, lung disease or who smoke, who need extra attention
- Patients with a leg or arm wound from vein or artery harvest for bypass, which also needs care
- Carers and family who help at home after discharge
Everyday care and protection of the breastbone
- Keeping the wound clean and dry
- Follow your team's advice about showering, drying the wound gently and when dressings can be removed. Do not apply creams or powders unless advised.
- Protecting the breastbone
- For about six to eight weeks, or as advised, avoid heavy lifting, pushing or pulling, and use a hugging pillow when coughing or sneezing.
- Leg or arm wound
- Where a vein or artery was taken, keep the wound clean, and raise the leg when sitting, as advised, to reduce swelling.
- Sleeping and movement
- Sleeping on your back is often most comfortable at first. Avoid pushing up with your arms when getting out of bed; roll to the side.
- Good healing habits
- A balanced diet, good diabetes control, no smoking and gentle walking support wound healing.
Procedure overview
Step 1: In hospital
The nurses check the dressing and wound regularly and teach you how to look after it.
Step 2: Dressing and showering
The dressing is changed or removed as advised. You are told when you can shower and how to dry the wound.
Step 3: Daily checks
Look at the wound every day for redness, swelling, discharge or opening, including leg or arm wounds.
Step 4: Protecting the bone
Follow the movement advice, support the chest when coughing and avoid lifting and straining.
Step 5: Follow-up visits
The team checks the wound at your follow-up visits. Stitches, if not dissolving, are removed as advised.
Step 6: When to get help
Contact your doctor or hospital promptly for fever, wound discharge, worsening pain, redness or any movement or clicking of the breastbone.
Clinical advantages
- Helps the wound and breastbone heal well
- Lowers the risk of infection and wound complications
- Problems found early are easier to treat
- Helps patients feel confident and recover more comfortably
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- Wound infection, which may need antibiotics or sometimes a further operation
- Breastbone that heals poorly or moves (sternal instability)
- Delayed healing, particularly in people with diabetes, obesity or who smoke
- Scarring, numbness around the wound or long-lasting discomfort
- Leg or arm wound problems, such as swelling, infection or slow healing
Frequently asked questions
When can I shower?
Your team will tell you, usually within a few days of surgery. Let water run over the wound and pat it dry; do not scrub.
What movements should I avoid?
Heavy lifting, pushing or pulling, and straining. Your surgeon will tell you how long, often six to eight weeks.
Is a clicking feeling in my chest normal?
A clicking, grinding or moving feeling in the breastbone should be reported to your doctor, as it may mean the bone is not healing properly.
How can I reduce the risk of infection?
Keep the wound clean and dry, control blood sugar, avoid smoking, eat well and follow all advice. Report any warning signs early.
When should I call the doctor?
If you have fever, redness, swelling, discharge, an opening in the wound, worsening pain or the bone feels unstable, contact your doctor or hospital without delay.
Patient-friendly summary
Looking after the breastbone wound after heart surgery helps it heal and lowers the risk of infection. Keep it clean and dry, protect the breastbone from strain and report warning signs early. Follow the advice of your surgical team, since needs differ from patient to patient.