Jo Taehee, Hur Joon, Kim Eun Key
Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2022 Jan;70(1):56-64. doi: 10.1055/s-0040-1722733. Epub 2021 Feb 4.
Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device.
Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed.
Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6-26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11-29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures.
We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.
小儿胸骨伤口并发症（SWC）包括无菌性伤口裂开（SWD）和浅表/深部胸骨伤口感染（SSWI/DSWI），一般通过反复清创和手术缝合伤口来处理。在此，我们报告一种小儿胸骨切开术伤口并发症的新型非手术管理策略，即采用连续无创伤口闭合技术结合一次性负压伤口治疗（PICO）装置。
9例SWC患儿采用皮肤粘贴胶带连续闭合及连续应用PICO装置进行处理。未进行彻底的手术清创或手术缝合。
3例临床诊断为SWD，2例为SSWI，4例为DSWI。所有伤口均未出现明显的纵隔炎或骨质破坏。术后16.1天（范围：6 - 26天）开始应用PICO装置，同时用皮肤胶带连续闭合伤口。PICO装置的平均使用时间为16.9天（范围：11 - 29天），所有患者伤口均实现闭合。无一例患者接受激进的手术清创或缝线侵入性手术缝合。
我们报告了采用连续无创伤口闭合技术结合PICO装置成功处理部分小儿SWC的经验。
