Lindstedt Sandra, Ingemansson Richard, Malmsjö Malin
Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
J Cardiothorac Surg. 2011 Mar 30;6:42. doi: 10.1186/1749-8090-6-42.
There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT), of which right ventricular heart rupture is the most devastating. The use of a rigid barrier has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up against the sharp edges of the sternum. The aim of the present study was to determine whether a rigid barrier can be safely inserted over the heart with regard to the sternum wound edge movement.
Sternotomy wounds were created in eight pigs. The wounds were treated with NPWT at -40, -70, -120 and -170 mmHg in the presence and absence of a rigid barrier between the heart and the edges of the sternum. Wound contraction upon NPWT application, and wound distension under mechanical traction to draw apart the edges of the sternotomy were evaluated.
Wound contraction resulting from NPWT was similar with and without the rigid barrier. When mechanical traction was applied to a NPWT treated sternum wound, the sternal edges were pulled apart. Wound distension upon traction was similar in the presence and absence of a the rigid barrier during NPWT.
A rigid barrier can safely be inserted between the heart and the edges of the sternum to protect the heart and lungs from rupture during NPWT. The sternum wound edge is stabilized equally well with as without the rigid barrier during NPWT.
与负压伤口治疗（NPWT）相关的死亡和严重并发症的报道日益增多，其中右心室心脏破裂最为严重。有人建议使用刚性屏障，通过防止心脏被拉向胸骨的尖锐边缘来预防这种致命并发症。本研究的目的是确定就胸骨伤口边缘移动而言，刚性屏障能否安全地插入心脏上方。
在八头猪身上制造胸骨切开伤口。在心脏与胸骨边缘之间存在和不存在刚性屏障的情况下，分别在-40、-70、-120和-170 mmHg的负压下对伤口进行NPWT治疗。评估应用NPWT时的伤口收缩情况，以及在机械牵引以拉开胸骨切开边缘时的伤口扩张情况。
使用和不使用刚性屏障时，NPWT导致的伤口收缩情况相似。当对接受NPWT治疗的胸骨伤口施加机械牵引时，胸骨边缘被拉开。在NPWT期间，存在和不存在刚性屏障时，牵引时的伤口扩张情况相似。
可以在心脏与胸骨边缘之间安全地插入刚性屏障，以保护心脏和肺部在NPWT期间不发生破裂。在NPWT期间，使用刚性屏障和不使用刚性屏障时，胸骨伤口边缘的稳定性相同。
