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

Abstract

Background: Surgical site complications (SSCs) after median sternotomy, such as deep sternal wound infection and sternal dehiscence, are rare but can be catastrophic. If undetected, there is an elevated risk of mortality. Reconstructive surgery consisting of debridement, sternectomy, and muscle flap coverage is widely used as standard of care for deep sternal wound infection. Methods: This was an observational, retrospective cohort study of patients with SSCs following index cardiothoracic procedures. A single surgeon performed chest wall reconstruction using muscle flaps followed by closed incision negative pressure therapy (ciNPT; −125 mm Hg) using a ciNPT specialty dressing with an expanded coverage area to resolve sternal defects. Dressing changes occurred every 7 days. Postoperative follow-up appointments occurred after 30 days. Results: Sixteen consecutive sternal reconstruction patients (six women and 10 men) with multiple comorbidities and an average age of 61.1 years were included in an initial evaluation of the ciNPT specialty dressing over median sternotomy incisions revised using flaps. The duration of ciNPT was 14 days with a single dressing change at day 7. At the initial dressing change, 93.8% of incisions were closed. Within 30 days postreconstruction, 18.8% of the patients had SSCs (hematoma or dehiscence). No seromas were noted. At 30-day follow-up appointments, 93.8% of incisions remained closed. Patients reported reduced pain and swelling. Average inpatient length of stay was 12.2 ± 14.2 days. Conclusion: In these patients, ciNPT using the ciNPT specialty dressing helped to facilitate positive healing outcomes in patients with deep sternal wound infections following sternal defect reconstruction post cardiothoracic surgery.

Negative Pressure Wound Therapy for Gas Gangrene of the Fingertip with Prolonged Infection

“…Negative pressure wound therapy (NPWT) is a relatively new treatment strategy. Owing to its excellent wound healing effect, it is used to treat a wide range of conditions, 1 , 2 such as traumatic wounds, 3 pressure sores, open abdomens, sternal wounds, 4 diabetic foot, 5 second-degree burns, skin flaps, 6 and skin graft recipient sites. 7 However, no study has examined and reported on treating fingertip infection–associated soft tissue defects using NPWT.…”