Cardiac Rupture During Vacuum-Assisted Closure Therapy

Sartipy, Ulrik; Lockowandt, Ulf; Gäbel, Jakob; Jidéus, Lena; Dellgren, Göran

doi:10.1016/j.athoracsur.2006.01.060

Cited by 74 publications

(52 citation statements)

References 4 publications

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“…One of the major advantages of applying NPWT to sternotomy wounds is that it stabilizes the sternum, which facilitates respiration and allows early mobilization [5,6]. However, complications associated with bleeding and heart rupture with lethal outcome have been reported in several studies [2,4,12]. The insertion of a rigid barrier between the heart and the sharp edges of the sternum has been suggested to prevent such complications [10].…”

Section: Discussionmentioning

confidence: 99%

“…There are, however, 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 [2-4]. In November 2009, the FDA filed an alert, and the importance of protecting exposed organs during NPWT and this issue has also been emphasized in the international scientific literature [5-8].…”

Section: Introductionmentioning

confidence: 99%

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Sternum wound contraction and distension during negative pressure wound therapy when using a rigid disc to prevent heart and lung rupture

Lindstedt

Ingemansson

Malmsjö

2011

J Cardiothorac Surg

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sternum wound contraction and distension during negative pressure wound therapy when using a rigid disc to prevent heart and lung rupture

Lindstedt

Ingemansson

Malmsjö

2011

J Cardiothorac Surg

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“…There are, however, increasing numbers of reports of deaths and serious complications associated with the use of NPWT, where right ventricle rupture and bypass graft rupture resulting in death are the most devastating complications; the incidence being 4 to 7% of the patients treated for deep sternal wound infection with NPWT after cardiac surgery [7-9]. We have previously described the cause of heart rupture in pigs using magnetic resonance imaging [10,11].…”

Section: Introductionmentioning

confidence: 99%

A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy

Lindstedt

Ingemansson

Malmsjö

2011

J Cardiothorac Surg

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ObjectivesRight ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.MethodsSixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.ResultsAfter 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm2 when no protective disc was used, and 1.15 ± 0.19 cm2 when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.ConclusionInserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.

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“…Repeated laboratory values were used to monitor these parameters which remained stable throughout the case. Hemorrhage as a result of VAC is reported sparsely in the literature [27][28][29]. Furthermore, tibial artery erosion secondary to treatment with VAC was described recently in a traumatic open fibular wound report [27].…”

Section: Discussionmentioning

confidence: 99%

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

Shomper

Coutin

Lanz

2013

Case Reports in Veterinary Medicine

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Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM) pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC) in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap.

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Cardiac Rupture During Vacuum-Assisted Closure Therapy

Cited by 74 publications

References 4 publications

Sternum wound contraction and distension during negative pressure wound therapy when using a rigid disc to prevent heart and lung rupture

Sternum wound contraction and distension during negative pressure wound therapy when using a rigid disc to prevent heart and lung rupture

A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

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