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

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.

C‐reactive protein and leucocyte counts drop faster using the HeartShield® device in patients with DSWI

“…Heart and lung ruptures similar to those seen in patients were observed in this experimental set‐up without the rigid discs, whereas no damage to the heart or lungs was seen when the discs were used . Extensive experiments have been performed on pigs, and four articles have been published demonstrating improved drainage, better haemodynamics, good wound stability and less haematoma and bleeding in the heart and lungs .…”

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

“…Robicsek [ 10 ] believed that RV rupture results from the sudden impact (not continuous) of the RV, in the exposed mediastinum, being squeezed against the restraining edges of the sternum by pressures in the lung and pleural cavities exceeding 300 - 600 mmHg when the patient coughs or struggles. Nevertheless, following their line of thought, Lindstedt and colleagues [ 13 ], in the same volume of the Journal , present a novel solution to prevent the bulging, which they attribute to NPWT: a rigid disk. Though the idea is applaudable, it may not be sufficient.…”