Negative Pressure Wound Therapy for Prevention and Treatment of Poststernotomy Complications in Adult Cardiac...

Sternal wound complications following cardiac surgery increase reoperation risk, prolong hospitalization, and complicate postoperative cardiovascular recovery, yet optimal prevention strategies remain poorly defined. We performed a systematic review with quantitative synthesis of 31 studies enrolling 6,420 adult cardiac surgery patients to evaluate the usefulness of negative pressure wound therapy (NPWT) compared with conventional dressings for preventing and managing poststernotomy wound complications. The pre-specified primary analysis focused on prophylactic NPWT applied over closed sternotomy incisions, since open and closed-incision applications represent fundamentally distinct populations with non-comparable outcomes. Within this primary analysis, prophylactic foam-based closed-incision NPWT (ciNPT) in high-risk sternotomy patients showed the most consistent reduction in surgical site infection, with relative risk estimates of 0.25 to 0.94 across 7 studies enrolling 2,178 patients. Evidence for therapeutic NPWT in established sternal wound infections was directionally favorable but derived exclusively from observational studies. Interstudy heterogeneity precluded robust aggregate pooled conclusions. In conclusion, prophylactic ciNPT may be reasonable to consider in selected high-risk patients pending randomized trial confirmation.