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Thorac Cardiovasc Surg 2022; 70(01): 056-064
DOI: 10.1055/s-0040-1722733
Original Cardiovascular

Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach

Taehee Jo 
1   Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
,
Joon Hur
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Eun Key Kim
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract

Background Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device.

Methods Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed.

Results Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6–26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11–29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures.

Conclusion We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

Keywords

wound healing - wound infection - surgery - complications - sternum

Financial Disclosure

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.




Publication History

Received: 14 October 2020

Accepted: 06 December 2020

Article published online:
04 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Fu RH, Weinstein AL, Chang MM, Argenziano M, Ascherman JA, Rohde CH. Risk factors of infected sternal wounds versus sterile wound dehiscence. J Surg Res 2016; 200 (01) 400-407
    CrossrefPubMedGoogle Scholar
  • 2 Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth 2020; 34 (06) 1602-1613
    CrossrefPubMedGoogle Scholar
  • 3 Salehi Omran A, Karimi A, Ahmadi SH. et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality. BMC Infect Dis 2007; 7: 112
    CrossrefPubMedGoogle Scholar
  • 4 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38 (06) 563-576 , discussion 577
    CrossrefPubMedGoogle Scholar
  • 5 Agarwal JP, Ogilvie M, Wu LC. et al. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg 2005; 116 (04) 1035-1040 , discussion 1041–1043
    CrossrefPubMedGoogle Scholar
  • 6 Bakaeen FG, Haddad O, Ibrahim M. et al. Advances in managing the noninfected open chest after cardiac surgery: negative-pressure wound therapy. J Thorac Cardiovasc Surg 2019; 157 (05) 1891-1903.e9
    CrossrefPubMedGoogle Scholar
  • 7 Salazard B, Niddam J, Ghez O, Metras D, Magalon G. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis in the paediatric patient. J Plast Reconstr Aesthet Surg 2008; 61 (03) 302-305
    CrossrefPubMedGoogle Scholar
  • 8 Padalino MA, Carrozzini M, Vida V, Stellin G. Vacuum-assisted closure therapy for the treatment of poststernotomy wound dehiscence in neonates and infants. Thorac Cardiovasc Surg 2019; 67 (01) 55-57
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Hardwicke J, Richards H, Jagadeesan J, Jones T, Lester R. Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence. Ann R Coll Surg Engl 2012; 94 (01) e33-e35
    CrossrefPubMedGoogle Scholar
  • 10 Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg 2006; 30 (06) 898-905
    CrossrefPubMedGoogle Scholar
  • 11 Ramnarine IR, McLean A, Pollock JC. Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis. Eur J Cardiothorac Surg 2002; 22 (06) 1029-1031
    CrossrefPubMedGoogle Scholar
  • 12 Sherman G, Shulman-Manor O, Dagan O. et al. Vacuum-assisted closure for the treatment of deep sternal wound infection after pediatric cardiac surgery. Pediatr Crit Care Med 2020; 21 (02) 150-155
    CrossrefPubMedGoogle Scholar
  • 13 Kawajiri H, Aeba R, Takaki H, Yozu R, Iwata S. Negative pressure therapy for post-sternotomy wound infections in young children. Interact Cardiovasc Thorac Surg 2014; 19 (01) 102-106
    CrossrefPubMedGoogle Scholar
  • 14 Payne C, Edwards D. Application of the single use negative pressure wound therapy device (PICO) on a heterogeneous group of surgical and traumatic wounds. Eplasty 2014; 14: e20
    PubMedGoogle Scholar
  • 15 Hudson DA, Adams KG, Van Huyssteen A, Martin R, Huddleston EM. Simplified negative pressure wound therapy: clinical evaluation of an ultraportable, no-canister system. Int Wound J 2015; 12 (02) 195-201
    CrossrefPubMedGoogle Scholar
  • 16 Boyar V. Treatment of dehisced, thoracic neonatal wounds with single-use negative pressure wound therapy device and medical-grade honey: a retrospective case series. J Wound Ostomy Continence Nurs 2018; 45 (02) 117-122
    CrossrefPubMedGoogle Scholar
  • 17 DeFazio MV, Economides JM, Anghel EL, Mathis RK, Barbour JR, Attinger CE. Traction-assisted internal negative pressure wound therapy with bridging retention sutures to facilitate staged closure of high-risk wounds under tension. Wounds 2017; 29 (10) 289-296
    CrossrefPubMedGoogle Scholar