Primary sternal tuberculosis is very rare. Only few cases have been reported in the English-language literature. We present a case of primary sternal tuberculosis that had intractable drainage for 18 months. Diagnosis was confirmed with biopsy, and there were no other tuberculous foci. No improvement was achieved in the status of the wound despite 4 months of chemotherapy. We applied the principles as in bacterial osteomyelitis of sternum, resected the wound and covered it with a pectoralis major musculocutaneous rotational flap. The wound healed, and there was no recurrence 24 months after surgery.