How Save is Negative Pressure Therapy in Deep Sternal Wound Complications

Objectives: Negative pressure therapy is routinely used in deep sternal wound complications because of good overall results. Although efficacy has repeatedly been proven, the safety of these systems, however, is controversial discussed, especially in cases of direct contact with vascular structures.

Methods: In a retrospective study we analyzed complications of negative pressure therapy over a period of 12 years. 286 of 13.875 patients (2.1%) with deep sternal wound healing complications were retrieved who underwent negative pressure therapy with accumulated 3718 therapy days. Typically, the system was routinely changed every third day until closure was possible. Major complications (heavy bleeding of the heart chambers, great vessels, coronary bypasses, early mortality) and minor complications (minor bleedings, lung injuries; system failure with the necessity of premature change were analyzed.

Results: Over the entire period of 12 years 7 patients showed a major bleeding (2.4%). Two of them died (0.7%). 23 patients showed minor bleeding (8%) and 16 patients (5.6%) developed an air leak by lung injury. These patients received a surgical revision. 56 patients (19.6%) required premature change of the system because of a failure.

Conclusion: Major complication rates endangering the life of the patient are very low. Owing to the nature of the therapy system failures are often seen but can be considered as an immanent part of the therapy and not a complication. Aside from a prolonged hospitalization the therapy finds reasonable acceptance by the patients and is clearly less invasive as plastic surgery. In the hands of cardiac surgeons negative pressure therapy is a success story having minimized the adverse consequences of deep sternal wound complications formerly considered a major burden in cardiac surgery.

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