Abstract
BackgroundThere are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT), of which right ventricular heart rupture is the most devastating. The use of a rigid barrier has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up against the sharp edges of the sternum. The aim of the present study was to determine whether a rigid barrier can be safely inserted over the heart with regard to the sternum wound edge movement.MethodsSternotomy wounds were created in eight pigs. The wounds were treated with NPWT at -40, -70, -120 and -170 mmHg in the presence and absence of a rigid barrier between the heart and the edges of the sternum. Wound contraction upon NPWT application, and wound distension under mechanical traction to draw apart the edges of the sternotomy were evaluated.ResultsWound contraction resulting from NPWT was similar with and without the rigid barrier. When mechanical traction was applied to a NPWT treated sternum wound, the sternal edges were pulled apart. Wound distension upon traction was similar in the presence and absence of a the rigid barrier during NPWT.ConclusionsA rigid barrier can safely be inserted between the heart and the edges of the sternum to protect the heart and lungs from rupture during NPWT. The sternum wound edge is stabilized equally well with as without the rigid barrier during NPWT.
Highlights
The use of negative pressure wound therapy (NPWT) for the treatment of deep sternal wound infections has been shown to have remarkable effects on healing [1]
There are, increasing numbers of reports of deaths and serious complications associated with the use of NPWT due to heart rupture, lung rupture, bypass graft bleeding and death; the incidence being 4 to 7% of all patients treated for poststernotomy mediastinitis with NPWT after cardiac surgery [2,3,4]
The heart was shown to be drawn up towards the thoracic wall, the right ventricle bulged into the space between the sternal edges, and the sharp edges of the sternum protruded into the anterior surface of the heart, in some cases resulting in damage to the left ventricle of the heart or damage to a bypass graft to the right coronary artery [10]
Summary
The use of negative pressure wound therapy (NPWT) for the treatment of deep sternal wound infections has been shown to have remarkable effects on healing [1]. Multiple layers of paraffin gauze over the anterior portion of the heart did not prevent the heart from being deformed. These events could, be prevented by inserting a rigid plastic disc between the anterior part of the heart and the inside of the thoracic wall [10]. There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT), of which right ventricular heart rupture is the most devastating. The use of a rigid barrier has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up against the sharp edges of the sternum. The aim of the present study was to determine whether a rigid barrier can be safely inserted over the heart with regard to the sternum wound edge movement
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