Sternal Wound Complications: Results of Routine Use of Negative Pressure Wound Therapy

Abstract

Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in individuals with superficial and deep sternal wound dehiscence (SWD). We report our experience with NPWT to evaluate factors influencing effectiveness, duration of treatment and postoperative hospital stay. Methods: We reviewed 92 patients with postoperative SWD following a median sternotomy. Patients were divided into 2 groups: those with a superficial SWD (Group 1; 72, 78%) and those with a deep SWD (Group 2; 20, 28%). Group 1 was further divided into 3 subgroups based on NPWT duration. Results: In both groups, none of the preoperative characteristics examined showed a significant association with longer NPWT duration. In Group 2, there was a trend for postoperative bleeding and neurological complications to be associated with longer treatment duration. In the entire series, staph infection resulted a weak predictor of NPWT duration. In each Group 1 subgroup and in Group 2, treatment days were compared with duration of hospitalization until discharge. Mean post-NPWT hospital stay was 6 days in subgroup 1, 12 days in subgroup 2 and 20 days in subgroup 3 (P<0.0001). At a median 3-year follow-up, there were 4 late deaths, none related to wound complications. No cases of SWD recurrence were observed. Conclusion: Our results confirm the effectiveness of NPWT in SWD management, while excessive treatment duration might have a negative impact on the length of hospital stay. Further studies are needed to define an optimal use of NPWT protocol.

Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis

“…However, it should be noted that patients with only sternal wound dehiscence, which were excluded from this study, would likely benefit from NPWT alone. 22 Limitations to our study should be acknowledged. First, the retrospective nature of the study limits the ability to draw conclusions regarding causality.…”

“…recently demonstrated in a national database study that delayed flap closure for DSWI is associated with increased mortality. However, it should be noted that patients with only sternal wound dehiscence, which were excluded from this study, would likely benefit from NPWT alone 22 …”

Using Closed Incision Negative Pressure Therapy Specialty Dressings over Incisions following Sternal Dehiscence Reconstruction

“…19 NPWT use has been reported in patients following primary and revised cardiothoracic surgery with reduced incidence of hematoma and SSIs, and shortened hospital LOS. [20][21][22] With the postoperative improvements associated with NPWT use over closed incisions, a ciNPT system designed specifically for surgical incision management was developed.…”

Surgical Site Infection in Cardiac Surgery

“…The prophylactic use of NPWT, e.g., Prevena (KCI) or PICO (Smith and Nephew), helps to hold wound edges together to prevent dehiscence, decreases lateral tension and oedema, increases tissue perfusion, stimulates granulation and reduces bacterial colonisation by isolating the wound from potential sources of contamination [ 31 , 136 , 137 ]. Prospective non-randomised studies comparing the elective use of NPWT with standard wound closure techniques in a group of patients at high risk of mediastinitis undergoing open heart surgery demonstrated a significant reduction in postoperative SSI incidence [ 138 , 139 , 140 ]. Despite the lack of randomised controlled studies, some societies recommend the prophylactic use of NPWT in cardiac surgery patients at high risk of mediastinitis [ 26 , 84 ].…”