oa Guidelines For The Use Of Negative Pressure Incision Management To Reduce Wound Complications Following Heart Surgery

Background: Negative Pressure Wound Therapy (NPWT) is well-established in the management of infected surgical wounds. However, it is a relatively new modality of treatment for the protection of clean surgical sites. This study was aimed at developing guidelines for the use of negative pressure incision management to prevent surgical wound complications after heart surgery. Methods: In this prospective study, we included 134 patients at high risk for sternotomy wound complications from September 2011 to June 2014. Selection criteria included: obesity, diabetes, smoking and COPD, fragile sternum, bilateral mammary arteries, delayed primary closure and repeated operations. We applied negative pressure of - 125 mm Hg on the wounds of 67 patients immediately following skin closure, the dressing was removed after 5 to 7 days. The results were compared to a control group with matching criteria (n=67) who had standard dressings. The primary end point of the study was the development of wound complications including surgical site infection, hematoma formation and sternal dehiscence within 30 days. Results: 2 of the 67 patients who underwent negative pressure incision management developed superficial surgical site infection within the 30 days postoperative period (2.99%). The wound infection of the two patients settled with regular dressings and oral antibiotics. While in the control group with conventional wound dressings (n=67), 5 patients developed superficial surgical site infection and one patient suffered a deep sternal wound infection (total 6 out of 67 patients, 8.96%). Based on our experience, we have proposed some selection criteria for the use of negative pressure incision management following heart surgery (table1). Conclusions: Negative pressure is potentially beneficial in the reduction of wound complications. There are no published criteria so far for the application of negative pressure on clean surgical sites post cardiac surgery. Therefore, we proposed some guidelines for the use of negative pressure incision management to protect high risk sternotomy wounds.