Khalpey Zain, Kumar Ujjawal, Khalpey Zacharya I, Hitscherich Pamela, Chnari Evangelia, Long Marc
Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA.
Khalpey AI Lab, Applied & Translational AI Research Institute (ATARI), Scottsdale, USA.
Cureus. 2024 Nov 9;16(11):e73322. doi: 10.7759/cureus.73322. eCollection 2024 Nov.
Objectives Wound dehiscence is defined as the partial or complete separation of the layers of a surgical wound. Wound dehiscence and infections are of significant concern in the field of surgery as they can lead to a range of complications, including infection, delayed healing, increased healthcare costs, and patient discomfort. For patients at high risk of sternal wound dehiscence and infection, optimization of wound closure is critical. Novel technologies are increasingly being developed to optimize wound closure following median sternotomy for cardiac surgery. Aseptically processed amnion-chorion placental allografts (aACPA) are one such example. Placental allografts maintain the inherent growth factors and matrix proteins native to the tissue, all of which are known in the literature for their roles within the natural closure of wounds Methods Twenty-six patients who underwent cardiac surgery requiring a median sternotomy at a single center undertaken by a single surgeon were included in this study. All patients included were deemed high-risk for sternal complications and had at least one sternal risk factor. Before closure, 160 mg of aACPA was added to the sternotomy wound to support wound repair. Data were collected for rates of sternal complications, as well as general demographics and past medical history of patients included in this study, and appropriate analyses were carried out. Results At their 14- and 30-day follow-up visits, none of the patients had experienced sternal wound dehiscence or infection, with their sternotomy wounds showing excellent signs of normal wound closure. A comprehensive sternal pain evaluation was carried out, which elicited no significant pain in any patients, a sign that sternal closure was successful and stable. The addition of the aACPA into our clinical practice has also contributed to no longer requiring postoperative chest stabilization adjuncts, resulting in significant financial and resource savings for our group. Conclusions In this study, the amnion-chorion placental allograft showed promise as an effective solution to support sternal wound closure in high-risk patients. Its inherent growth factors and ECM (extracellular matrix) may directly address the specific challenges faced by these high-risk individuals. This innovative treatment offers a novel and advanced approach to support wound closure in patient populations that are particularly vulnerable to complications.
目标 伤口裂开被定义为手术伤口各层的部分或完全分离。伤口裂开和感染在外科领域备受关注，因为它们会导致一系列并发症，包括感染、愈合延迟、医疗费用增加以及患者不适。对于有胸骨伤口裂开和感染高风险的患者，优化伤口闭合至关重要。越来越多的新技术正在被开发出来，以优化心脏手术正中开胸术后的伤口闭合。无菌处理的羊膜 - 绒毛膜胎盘同种异体移植物（aACPA）就是这样一个例子。胎盘同种异体移植物保留了组织固有的生长因子和基质蛋白，所有这些在文献中都因其在伤口自然闭合中的作用而为人所知。方法 本研究纳入了由单一外科医生在单一中心进行正中开胸心脏手术的26例患者。纳入的所有患者均被认为有胸骨并发症的高风险且至少有一个胸骨风险因素。在伤口闭合前，向开胸伤口添加160毫克aACPA以支持伤口修复。收集了本研究中患者的胸骨并发症发生率以及一般人口统计学和既往病史数据，并进行了适当分析。结果 在14天和30天的随访中，没有患者发生胸骨伤口裂开或感染，其开胸伤口显示出正常伤口闭合的良好迹象。进行了全面的胸骨疼痛评估，没有任何患者出现明显疼痛，这表明胸骨闭合成功且稳定。将aACPA添加到我们的临床实践中还使得不再需要术后胸部稳定辅助装置，为我们的团队节省了大量资金和资源。结论 在本研究中，羊膜 - 绒毛膜胎盘同种异体移植物显示出有望成为支持高风险患者胸骨伤口闭合的有效解决方案。其固有的生长因子和细胞外基质（ECM）可能直接应对这些高风险个体面临的特定挑战。这种创新治疗为支持特别易发生并发症的患者群体的伤口闭合提供了一种新颖且先进的方法。
