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Tremendous bleeding complication after vacuum-assisted sternal closure.

Arndt H Kiessling¹, Andreas Lehmann, Frank Isgro

¹Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. cardiac.surgeon@dr-kiessling.com

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|February 11, 2011

Summary

Vacuum-assisted closure (VAC) effectively treats complex wounds. However, ensure all sternal fragments are removed before applying negative pressure to prevent severe bleeding complications.

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Area of Science:

Surgical innovation
Wound management
Cardiac surgery complications

Background:

Vacuum-assisted closure (VAC) is increasingly used for complex infected wounds.
The VAC system utilizes negative pressure to aid wound healing.
Effectiveness in improving microcirculation and granulation is established.
No contraindications for deep sternal wounds in cardiac surgery were previously noted.

Observation:

A case report details severe ascending aorta bleeding in a cardiac surgery patient.
Bleeding was caused by wire fragments penetrating the vessel during VAC therapy.
The patient had undergone sternal closure with wire fragments potentially remaining.

Findings:

The effectiveness of VAC in promoting wound healing is well-documented.
This case highlights a critical risk associated with retained sternal fragments.
Inadequate removal of foreign material can lead to catastrophic vascular complications.

Implications:

Thorough removal of all foreign particles in the sternum is crucial before VAC application.
This finding necessitates a re-evaluation of pre-VAC protocols in cardiac surgery.
Enhanced vigilance is required to prevent VAC-related hemorrhage in sternal wound management.