Soru

During morning rounds on the surgical step-down unit, a $57$-year-old male patient is evaluated for worsening shortness of breath and severe anterior chest pain. He is currently on postoperative day $7$ following an open mitral valve replacement and single-vessel coronary artery bypass graft. His medical history includes type 2 diabetes mellitus, medically managed obesity, and a $35$-pack-year smoking habit. The pain is described as deep and sharp, exacerbating significantly when he coughs.

Vital signs show a temperature of $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), pulse of $118/\text{min}$, respirations of $24/\text{min}$, and blood pressure of $92/64 \text{ mm Hg}$. Physical examination reveals a diaphoretic, ill-appearing man. Inspection of the midline sternotomy incision demonstrates marked surrounding erythema and a $2\text{-cm}$ separation of the proximal wound edges. A moderate amount of cloudy, malodorous exudate is draining from the defect. Upon palpation of the chest wall during respiration, the two halves of the sternum shift independently of one another. Laboratory studies are significant for a leukocyte count of $19,500/\text{mm}^3$.

Which of the following is the most appropriate next step in the management of this patient's condition?