Early Wound and Sternal Management Following Pediatric Cardiac Surgery

Area of Science:

• Pediatric Cardiology
• Surgical Wound Management
• Congenital Heart Surgery

Background:

• Early postoperative wound management after congenital heart surgery lacks standardized protocols.
• Current practices vary widely, potentially impacting patient quality of life, development, and access to care.
• The effects of different wound management strategies on healing and complications are not well understood.

Purpose of the Study:

• To survey North American pediatric heart centers on their current practices for early postoperative wound and sternal management.
• To identify variations in wound closure, use of wound vacuum-assisted closure (VAC), and sternal precautions.
• To highlight the need for research into evidence-based standards of care.

Main Methods:

• A survey was distributed to member centers of the Pediatric Acute Care Cardiology Collaborative.
• Descriptive statistics were used to analyze responses regarding wound closure, VAC use, sternal precautions, and activity restrictions.
• Data were collected from 35 out of 46 (76%) participating centers.

Main Results:

• Most centers use primary skin closure with subcutaneous sutures; wound cover removal timing varies.
• Wound VAC use is common (33 centers), but patient selection and therapy duration differ.
• Significant variability exists in sternal precaution duration, activity/bathing restrictions, and waiting periods before subsequent procedures.

Conclusions:

• Postoperative wound and sternal management following pediatric congenital heart surgery is inconsistent across major North American centers.
• Current diverse practices, including restrictive measures, may negatively influence length of stay, quality of life, and neurodevelopment.
• Further research is essential to establish evidence-based guidelines for wound and sternal management to optimize outcomes and patient well-being.