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Comparing Negative Pressure Wound Therapy with Instillation and Conventional Dressings for Sternal Wound Reconstructions

Chowdhry, Saeed A., MD, FACS*; Wilhelmi, Bradon J., MD, FACS

Plastic and Reconstructive Surgery – Global Open: January 4, 2019 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002087
Latest Articles: PDF Only

Background: Muscle flap reconstruction has become a mainstay of therapy following treatment of sternal wound complications; however, success depends on removing wound exudate and infectious material from the wound before reconstruction and closure. Importantly, time to closure is a key factor affecting morbidity/mortality and cost-to-treat for this wound type.

Methods: A retrospective analysis of 30 patients who were treated for sternal wound complications between June 2015 and October 2017 was performed. After surgical debridement, group 1 patients (n = 15) received negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d), instilling 1/8-strength Dakin’s solution with a 20-minute dwell time followed by 2 hours of NPWT (-125 mm Hg); group 2 patients (n = 15) were treated with wet-to-moist dressings soaked in 1/8-strength Dakin’s solution. After muscle flap reconstruction and closure with sutures, group 1 patients received closed incision negative pressure therapy, and group 2 patients received Benzoin and wound closure strips. Data collected included time to closure, therapy duration, number of debridements/dressing changes, drain duration, and complications.

Results: There was a significantly shorter time to closure (P < 0.0001) for group 1 when compared with group 2. In addition, there were fewer therapy days (P = 0.0041), fewer debridements/dressing changes (P = 0.0011), and shorter drain duration (P = 0.0001) for group 1 when compared with group 2.

Conclusions: We describe a novel regimen consisting of adjunctive NPWTi-d, along with debridement and systemic antibiotics, followed by closed incision negative pressure therapy after muscle flap reconstruction and closure, to help manage preexisting sternal wounds that had failed to close following a previous cardiac procedure.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Departments of Clinical Sciences and Surgery, Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, Ill.

Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky.

Published online 4 January 2019.

Received for publication September 6, 2018; accepted October 9, 2018.

Disclosure: Dr. Chowdhry is a consultant for KCI USA, Inc., an Acelity company. Dr. Wilhelmi has no conflicting interests that are related to this study. The Article Processing Charge was paid for by the authors.

Saeed Chowdhry, MD, 4400 W 95th St, Suite 102, Oak Lawn, IL 60453, E-mail: chowdhrymd@gmail.com

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.