Evaluating the Application of a Closed Incision Negative Pressure Therapy Specialty Dressing Over Incisions Following Sternal Dehiscence Reconstruction Using Bilateral Flaps.

Abstract

Surgical site complications (SSCs) post median sternotomy, such as sternal dehiscence, have an incidence of 0.06% to 12.50%.1-5 If undetected, perioperative mortality may be as high as 47%.4,5 Closed incision negative pressure therapy (ciNPT*) administers continuous subatmospheric pressure6,7, holds incision edges together, removes fluid and infectious materials, provides a barrier to external contaminants and mitigates the incidence of edema. Recently, a ciNPT specialty dressing with an expanded coverage area has been developed to protect incisions following mastoplasty. Here, the ciNPT specialty dressing was applied to incisions stemming from revised sternal dehiscences of patients (n = 4), who had developed SSCs following index cardiothoracic procedures. Two female and 2 male patients had a mean age of 52.8 ± 13.1 years. Comorbidities included: myocardial infarction, hypertension, coronary artery disease, hyperlipidemia, ischemic cardiomyopathy, and sternal osteomyelitis/surgical site infections. Patients provided informed consent for data collection and usage. Antibiotics were administered perioperatively. A single surgeon performed debridement and chest wall reconstruction with bilateral pectoral flaps to revise the dehiscence. Incisions measured 20 cm and were stapled or sutured; surgical drains were placed, as necessary. Immediately postoperatively, the ciNPT specialty dressing was placed over the closed incision and ciNPT (-125 mmHg) was initiated. Dressing changes occurred every 7 days. Two patients received ciNPT for 7 days. Two patients had 1 dressing change and received ciNPT for 14 days. One patient developed a hematoma (postoperative day [POD] 17). Incisions remained closed at dressing change/removal. Drains were removed between POD 7 and POD 34. Hospital length of stay ranged from 2-13 days. Patients reported pain and swelling were reduced. Incisions remained closed at 30-day follow-up appointments. There were no reports of flap failure post defect reconstruction. In these patients, the ciNPT specialty dressing facilitated positive healing outcomes following the revision of a sternal dehiscence.

*PREVENA RESTOR BELLA-FORM™ Incision Management System; PREVENA RESTOR BELLA-FORM™ Dressing; PREVENA RESTOR™ Therapy (KCI; Now a part of 3M, San Antonio, Texas)

References

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