How Safe is the Combination of Negative Pressure Therapy and Polyhexanid Instillation in Deep Sternal Wound Complications?

Objectives: Negative pressure therapy is routinely used in deep sternal wound complications. In recent years the combination of vacuum assist closure and instillation with antiseptic solution has become an additional option for these patients. However, this therapy is controversially discussed, especially is cases of direct contact with mediastinal and heart structures. In this retrospectively study, we looked at safety and efficacy of negative pressure therapy combined with DAB 7/0.02% polyhexanid (Lavanid 1% solution) instillation in such patients.

Methods: Safety and efficacy of this therapy was observed over a period of 3 years. Forty-two patients with deep sternal wound healing complications were included. All patients were otherwise submitted to a standardized regime. Negative pressure of 125 mm Hg was used over 3.5 hours followed by 10 minutes instillation time with Lavanid 1% solution. The system was regularly changed in every 3 days. Major complications (heavy bleeding from heart and great vessels, death) and minor complications (minor bleedings, lung injuries, and premature change of the system) were assessed. We compared the results with a propensity score matched control group of identical size (n = 42) in which standardized negative pressure therapy without instillation was performed.

Results: In comparison with the control group the treatment group showed a significant shorter time period to secondary wound closure (11.2 vs. 8.7 days; p = 0.017). Over the whole period of 3 years there was only one patient with a major bleeding. No death occurred. Two patients showed a minor bleeding and two patients developed an air leak by lung injury. In two patients the instillation resulted in pleural effusion with the necessity of a revision. System failure was observed in five patients resulting in premature system changes.

Conclusion: The new therapy significantly reduced the time until secondary wound closure while complications rates were almost as low as in standard vacuum therapy. Combination of negative pressure therapy and Lavanid 1% instillation in deep sternal wound healing complications is safe and effective. A prospective randomized trial is needed to assess as to whether this therapeutic strategy my eventually replace standard vacuum therapy.