Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach

Abstract

Background Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. Methods Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. Results Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6–26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11–29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. Conclusion We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

Efficiency of an algorithm for the prevention of sternal infection after cardiac surgery in children under 1 year of age: A single-center retrospective study

“…It has a significant impact on patient outcomes. The incidence of this complication in children after cardiac surgery ranges from 1.5 to 34 % [ [1] , [2] , [3] , [4] , [5] ]. The treatment of such complications is often associated with a high level of mortality, a significant increase in the duration and cost of hospital stay [ 6 , 7 ].…”

“…The treatment of such complications is often associated with a high level of mortality, a significant increase in the duration and cost of hospital stay [ 6 , 7 ]. One effective method of treatment is vacuum therapy for infected wounds [ 1 , [8] , [9] , [10] ], especially if muscle flap repair of a wound defect is required. High early mortality rates are noted if sternal wound infection occurs.…”