[Verse 1] Sternum left open, they call it delayed closure, wires loose, chest guarded like a hinge with no composure, re-exploration stacks the odds, ICU clock keeps ticking, sugar running wild in diabetic blood, immune system kicking weak — obesity loads the tissue, fat starves the healing, staph camped on the skin before the knife starts peeling. Watch for dehiscence — that's the wound splitting wide, edges pulling apart where the sternum used to hide. [Chorus] Debride the dead, drown it in drugs six weeks strong, vacuum seals the gap till the flap comes along, muscle rotated in, covering the breach, infection's a lecture, listen what it teach. Turbulent flow, fibrin lays the floor, bacteria adhere to the graft and ask for more, bovine jugular binds staph tighter than bone, homograft stands cooler, harder to dethrone. [Verse 2] Culture comes back positive, pus where the plate should mend, first move's surgical — debridement, not just a friend of antibiotics alone, you gotta cut the dead away, prolonged IV course while the wound bed learns to stay clean, negative pressure therapy — the vacuum dressing pulls fluid out, granulation grows, the cavity it culls down to nothing, then the pectoralis or rectus flap rotates to fill the space, closing off the gap. [Verse 3] Now inside the chest, the conduit's got its own war, stenotic leaflets churn the blood, turbulence at the core, fibrin-platelet clumps form friable little nests — crumbly, fragile vegetations where bacteria rest. S. aureus loves the bovine jugular's collagen bed, binds it more avidly than homograft instead, that's why Contegra and Melody carry the heavier load, late infections recurring, sometimes explant's the road. [Chorus] Debride the dead, drown it in drugs six weeks strong, vacuum seals the gap till the flap comes along, muscle rotated in, covering the breach, infection's a lecture, listen what it teach. Turbulent flow, fibrin lays the floor, bacteria adhere to the graft and ask for more, bovine jugular binds staph tighter than bone, homograft stands cooler, harder to dethrone. [Verse 4] Diagnosis leans on Duke-ISCVID's careful frame, blood cultures drawn in triplicate, chasing down the name, TEE finds the vegetation clinging to the wall, PET-CT lights the metal up if cultures stall. Six weeks of IV antibiotics, narrow then precise, but obstruction, abscess, bacteremia won't think twice — surgery steps in when the graft can't be saved, explant and replace it, the pathway gets paved. [Bridge] Delayed closure, diabetic, obese, re-explored — remember the risks before the sternum's restored. Turbulence breeds thrombus, thrombus breeds the stay, bacteria ride the current till they find a place to lay. [Outro] Debride, treat, culture, scan — the cycle's understood, protect the conduit's lining like you promised that you would, six weeks of drugs, a vacuum's kiss, a flap to seal the door, infection's a lecture — now you know the score.
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