Remote skin injury: a protean complication of open heart surgery

In the 12-month period ending August, 1984, 14 adult patients (2.9%) developed within 24 hr following open heart surgery skin defects of varying magnitude remote from the incision site. Electrical injury secondary to a grounding defect was documented in two patients and suspected in one. Four patients' injuries were caused by the roller device when transfering from operating room table to intensive care unit bed. The remaining eight patients all had skin loss at sites of pressure on either the head, back, buttocks, or arm. Retrospective analysis showed no correlation with mean pressure during cardiopulmonary bypass (CPB), depth of cooling, length of time to rewarm, or the use vasoactive drugs. Subsequently, core temperature plus ten surface temperatures were monitored during and following CPB in ten patients. The data showed that during active cooling and rewarming, skin temperature actually lagged behind the core temperature (4 C). Thus, the skin appears to develop a relative oxygen debt during CPB which may decrease the threshold for skin injury particularly in older patients who may have other predisposing factors, such as obesity, generalized atherosclerosis, diabetes, or friable skin. Pressure points during positioning and subsequent skin trauma must be meticulously avoided in any patient undergoing CPB.