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Published on: March 26, 2018
Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach
Taehee Jo1, Joon Hur2, Eun Key Kim2
1Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
Insights
This study presents a new nonsurgical approach for pediatric sternal wound complications (SWCs). Combining adhesive skin tapes with negative pressure wound therapy (PICO) successfully managed SWCs without surgery.
Area of Science:
- Pediatric Surgery
- Wound Management
- Medical Devices
Background:
- Pediatric sternal wound complications (SWCs) like dehiscence and infection are typically treated with debridement and surgical closure.
- A novel nonsurgical approach for pediatric SWCs is explored.
Purpose of the Study:
- To evaluate a new nonsurgical management strategy for pediatric sternal wound complications.
- To assess the efficacy of serial noninvasive wound approximation combined with negative pressure wound therapy.
Main Methods:
- Nine pediatric patients with SWCs were treated using serial approximation with adhesive skin tapes and a single-use negative pressure wound therapy (PICO) device.
- No surgical debridement or invasive approximation techniques were employed.
Main Results:
- The nonsurgical approach successfully achieved wound approximation in all nine patients.
- Patients included diagnoses of sterile wound dehiscence (SWD), superficial sternal wound infection (SSWI), and deep sternal wound infection (DSWI).
- Average PICO device use was 16.9 days, initiated 16.1 days postoperatively.
Conclusions:
- Serial noninvasive wound approximation with a PICO device offers a successful nonsurgical management option for selected pediatric SWCs.
- This method avoids the need for aggressive surgical debridement or sutures in pediatric sternal wound cases.
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.
