Cardiothoracic Wound Management in Pediatrics: A Scoping Review

Congenital heart defects represent the most prominent cause of mortality in a child's first year of life. Management of cardiothoracic wounds in pediatric populations is complex, attributed to the fragility of soft tissue, with healing progressing differently in adults. Understanding the breadth of wound care management is essential in establishing its applicability to clinical practice, especially in the prevention of complications.

The aim of this study was to expansively explore preoperative, intraoperative, and postoperative cardiothoracic wound care in pediatrics.

In this scoping review, a systematic search of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was conducted to retrieve interventional studies on pediatric cardiothoracic surgical patients (younger than 21 years) with wounds requiring intervention published in the preceding 10 years.

A total of 2379 studies were retrieved, with 23 studies included. This review predominantly consisted of observational studies (n = 13, 57%), with 2 randomized clinical trials (8.7%). Most studies focused on procedural interventions (n = 14, 41.2%), with an equal distribution of management-focused (n = 10, 29.4%) and bundle-focused (n = 10, 29.4%) interventions. Interventions were most used in the postoperative period (n = 68, 49.6%). Study authors typically assessed the association of pharmaceutical, dressing, mechanical, and decontamination interventions with the incidence of sternal wound infections, healing, other infections, nutrition, parental outcomes, and postoperative complications. Frequency of wound surveillance and dressing changes were heterogeneous and rarely reported among studies.

This review demonstrated the limited availability of high-level evidence evaluating the effectiveness of wound care interventions associated with pediatric cardiothoracic surgery. It is paramount that researchers leverage existing clinical networks to establish clinical trials.