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Dr. Andrew Rynne

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What causes swollen, itchy, and painful suture line long after a CABG surgery and during a herpes outbreak?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6643 Questions

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Posted on Wed, 26 Sep 2018 in Valvular Heart Disease
Question: I had Cabbage surgery last July. The suture line had healed with no problems. Now it is red and swollen it itches and hurts at the same time. I can't stand clothes touching it is so sensitive. I also have a fresh outbreak of my Herpes. I had Herpes for 20 plus years. I went to ER Thursday and they put me on Famciclovir 125mg tabs BID for five days. I have now been on it 4 days and it has not changed. Still swollen still red and still sensitive and itching. The Herpes is somewhat better. the Famciclovir is very expensive so I don't want to a refill. I was working on the chicken pen moving boards and I think that what got the suture line upset. What should I do next?
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:

Hello!

I passed carefully through your question and would explain that local skin infection are quite common in the suture line.

They can be mild uncomplicated local superficial skin infections, but they may also lead to serious infections affecting the sternum or the soft subcutaneous tissues.

The fact that you have local signs of inflammation (red, swollen, pain and itching), which do not improve from the antiviral therapy (famciclovir), may be indicative of a possible bacterial infection in this region, which may lead to sternitis or mediastinitis if left untreated.

Coming to this point, I would recommend performing some tests in order to investigate for the possible cause of your complaints:

- a chest X ray study
- an ultrasound of the soft tissues of the chest
- complete blood count
- PCR, ESR for inflammation.

A chest CT scan may be needed.

You should discuss with your doctor on the above tests.

Hope to have been helpful!

I remain at your disposal for any further questions, whenever you need!

Kind regards,

Dr. Ilir Sharka, Cardiologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 8 hours later
I am glad to say that the swelling seems to have gone down. The other symptoms remain the same. The cardiac surgeon who did the surgery and where I had it done is 200 miles away but I will call him tomorrow. The local cardiologist took over after my surgery. We are lucky to have a cardiologist here at all. This is a small town out in the desert of NM. I am afraid there a waiting list to see Dr. Rivers.
A skin infection on the suture line is common? It has been 7 months since the surgery. I say that should beyond that possibility
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:

Opinion as follows:

Detailed Answer:

Hello again!

You are right about the distant time from cardiac surgical procedure and the probability of peri-procedural infectious complications being clinically present at the surgical incision site.

But, as you are experiencing signs of local inflammation, a strong suspicion of an acute/subacute inflammation/infection remains firm.

I wish that it were just Herpes outbreak, but the persistence of complaints raises suspicions on a possible bacterial infection.

Surgical incisions are a common site of several infections (bacterial, mycotic, viral and even psoriasis in a preexisting disorder [Koebner phenomenon], etc.) even at a distant time from the surgery.

Sometimes a dehiscence of sternal sutures may be the reason of a similar clinical symptomatology.

That’s why it is necessary to discuss with your attending cardiologist on a careful physical exam and the above mentioned (inflammation and imagine) tests.

Hope I have answered your query. I remain at your disposal for any further discussions.

Wishing you good health!

Kind regards,
Dr. Ilir Sharka, Cardiologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Feeling discouraged. the swelling is back. I had some problems after surgery with swallowing. the tube had still been in my throat when I woke up and I guess I fought it. Now, this am it hurting up in that area again. I will try to contact my Cardiologist today. Wish me luck, she often gone then booked with patients when she gets back. ER is a mess
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:

I would explain:

Detailed Answer:

Hello!

You shouldn't worry too much about as an inflammation/infection when treated in a timely fashion may be easily controlled.

I think that the most important issue is to check any possible systemic inflammatory response by those recommended tests.

An abnormally high inflammatory response would be a marker of immediate demand of antibiotics and anti-inflammatory treatment.

I recommend you to check your blood pressure and refer those values to your doctor (cardiologist or internist).

Only in case your clinical symptomatology becomes concerning and you experience bouts of fever, you should ask immediate medical assistance to the nearest ER service at your living area.

Hope I have answered your query.

Wishing you good luck and all the best!

Kind regards,
Dr. Ilir Sharka, Cardiologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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