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

Introduction: 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*) provides continuous subatmospheric pressure6,7; helps holds incision edges together; removes fluid and infectious materials, which may help mitigate the incidence of edema; and provides a barrier to external contaminants. Recently, a ciNPT specialty dressing† with an expanded coverage area has been developed to protect surgical incisions.

Methods: Here, the ciNPT specialty dressing was applied to closed incisions stemming from revised sternal dehiscences of patients (n = 16), who had developed SSCs following index cardiothoracic procedures. Patients provided informed consent for data collection and usage. Antibiotics were administered perioperatively. A single surgeon performed debridement and chest wall reconstruction with either pectoral (unilateral/bilateral) or rectus abdominis flaps for dehiscence revision. Incisions (15 cm - 20 cm) 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.

Results: Six female and 10 male patients were included (mean age = 61.1 ± 11.6 years). Comorbidities included: myocardial infarction, hypertension, coronary artery disease, hyperlipidemia, ischemic cardiomyopathy, and sternal osteomyelitis/surgical site infections. All patients received ciNPT for 14 days with 1 dressing change at postoperative day (POD) 7. SSCs included hematoma (n = 2) and dehiscence (n = 1) associated with surgical site infection. In this study, 93.8% of patients treated with ciNPT had incisions that remained closed at dressing change/removal. Drains were removed between POD 5 and POD 34. Mean hospital length of stay was 12.2 ± 14.2 days. Patients reported reduced pain and swelling. Most incisions (93.8%) remained closed at 30-day follow-up appointments.

Discussion: There were no reports of flap failure post defect reconstruction. In these patients, the ciNPT specialty dressing helped to optimize care by managing the closed incision and surrounding soft tissue following the revision of a sternal dehiscence.