Vacuum-Assisted Closure Therapy for the Treatment of Poststernotomy Wound Dehiscence in Neonates and Infants

Editor's Note

We read with great interest the article titled “Vacuum-Assisted Closure Therapy for the Treatment of Poststernotomy Wound Dehiscence in Neonates and Infants” by Padalino et al.[1]

We think the article is very interesting, because the use of vacuum-assisted closure (VAC) therapy in the pediatric population is less frequent than the many existing studies for the adult patients and because there are no univocal standardized protocols, even if it is not clear how the author performed the reconstructive part for each patient specifically: maybe they used muscle flaps.

VAC therapy is effective because it removes exudates and debrides, increases blood perfusion by neovascularization, leads to the formation of granulation tissue, and increases the local circulation of antibiotics into the wound bed.[2]

For many years, we have used a similar approach in adult patients. The first step corresponds to the surgical debridement of the wound dehiscence, followed by placement of the VAC system; then wound cultures and, consequently, targeted antibiotic therapy are performed. The second step is the reconstructive one, which is achieved only after two consecutive negative wound cultures.

At the beginning of our experience, we used to perform a bilateral pectoralis major muscle advancement flap,[3] but then we started to resort to less invasive procedures, such as the unilateral pectoralis major muscle flap[4] or the split pectoralis flap.

Because deep sternal infection is a very severe disease with a mortality rate between 1 and 36%, our challenge for the future is to prevent the onset of wound dehiscence.[3] It would be possible by identifying patient risk categories as women, patients with chronic diseases, and smokers and treating them with the Negative Pressure Incision Management System (PREVENA™), immediately after the surgical reconstruction. This negative pressure therapy is a prevention system that protects the incision from external contamination, helps hold incision edges together, and removes any fluid and infection materials, when surgical incisions continue to drain following sutured or stapled closure.

• References

• 1 Padalino MA, Carrozzini M, Vida V, Stellin G. Vacuum-Assisted Closure Therapy for the Treatment of Poststernotomy Wound Dehiscence in Neonates and Infants. Thorac Cardiovasc Surg 2019; 67 (01) 55-57
• 2 Lo Torto F, Ruggiero M, Parisi P, Borab Z, Sergi M, Carlesimo B. The effectiveness of negative pressure therapy on infected wounds: preliminary results. Int Wound J 2017; 14 (06) 909-914
• 3 Carlesimo B, Lo Torto F, Rossi A, Marcasciano M, Ruggiero M. Long-term result of bilateral pectoralis major muscle advancement flap in median sternotomy wound infections. Eur Rev Med Pharmacol Sci 2014; 18 (24) 3767-3772
• 4 Lo Torto F, Monfrecola A, Kaciulyte J. , et al. Preliminary result with incisional negative pressure wound therapy and pectoralis major muscle flap for median sternotomy wound infection in a high-risk patient population. Int Wound J 2017; 14 (06) 1335-1339