Negative Pressure Wound Therapy for Closed Incisions and Deep Sternal Wound Infection after Median Sternotomy: Single-Center Experience

Background: Negative pressure wound therapy is well established for the treatment of deep sternal wound infection (DSWI). In contrast, evidence supporting a prophylactic treatment effect of negative pressure therapy on normally closed wounds (closed-incision negative pressure wound therapy, ciNPWT) in high risk patients for DSWI is limited. We applied ciNPWT in 108 patients with high risk of DSWI as judged by the operating surgeon and report our experience.

Method: From December 2014 to May 2017, a total of 108 patients with high perceived risk of DSWI received the Prevena ciNPT system. It was applied instead of the regular wound dressing after classic surgical skin closure. A negative pressure of −125 mm Hg was applied and maintained for 6 days. Wound and surrounding skin were inspected immediately after removal of the Prevena system and at POD 30. Propensity matching (1:2) was performed based on all procedures having received sternotomy in the same time period (n = 1,778). Fowler score was used to assess risk and binary logistic regression and multivariable analyses were performed to identify independent predictors for DSWI.

Results: Prevena patients were 67 + 9 olds and 77% were male. The majority of patients underwent CABG (77%) followed by combined and double valve procedures. Mean log. EuroSCORE was 10 + 14%. There was no mortality in this selected patient population. The Fowler score was 14.2 + 5.4, resulting in an expected wound infection rate of over 5%. Observed DSWI was present in 3 of 108 patients (3.24%). Propensity matching generated 2016 patients with identical clinical characteristics. Fowler score was 14.0 + 6.0. Observed DSWI was 4.2% which was numerically higher, but not significantly different to the Prevena group. Risk factors for DSWI were high body mass (OR: 1.10; p < 0.001), blood transfusion (OR: 1.09; p < 0.001), rethoracotomy (OR: 3.93, p < 0.01), reduced LVEF (regression coefficient: 0.03, OR: 0.98, p < 0.005) and CABG (regression coefficient: 0.89; OR: 2.35; p = 0.01).

Conclusion: Our results suggest that prophylactic negative pressure wound therapy may not convey the expected reduction in deep sternal wound infection.

Publication History

Article published online:
03 February 2022