title: Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence.
abstract: The use of topical negative pressure (TNP) dressings for sternal wound dehiscence or mediastinitis in the neonatal population is rare. The majority of case reports have focused on wound healing as an endpoint and have not discussed the physiological advantage that TNP dressings may  impart with regard to sternal stabilisation, improved respiratory function and early weaning from mechanical ventilation. We present a case of the use of TNP in neonatal post-sternotomy wound dehiscence and mediastinitis, from a UK perspective, with an emphasis on wound healing and physiological  optimisation. As well as an improvement in sternal wound healing due to the local effects of the TNP system, serial arterial blood gas analysis revealed a significant improvement in systemic physiological parameters, including a reduction in pCO(2) in the period (days 20-31)  after application of TNP (p<0.0001) compared to the period before where simple occlusive dressings were applied. Hydrogen ion concentration also significantly reduced in this period (p=0.0058). The use of the TNP system in association with systemic antibiotics successfully  treated the mediastinitis. A sealed, controlled wound environment also allowed ease of nursing and an expedited return to care by the parents. We would recommend the consideration of TNP dressings in similar cases of neonatal and paediatric sternal wound dehiscence. Not only do we observe  the local effects of improved wound healing, the systemic effects of improved lung function are also valuable in the early management of such complex cases.
authors.affiliation: Department of Plastic Surgery, Birmingham Children's Hospital, UK. hardwickej@doctors.org.uk
authors.forename: J
authors.initials: J
authors.lastname: Hardwicke
authors.forename: H
authors.initials: H
authors.lastname: Richards
authors.forename: J
authors.initials: J
authors.lastname: Jagadeesan
authors.forename: T
authors.initials: T
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Lester
mesh_terms: D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D018633:Pulmonary Atresia / Q000601:surgery*; D056346:Sternotomy / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy*; D018785:Tricuspid Atresia / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen