title: Use of Closed Incision Management with Negative Pressure Therapy for Complex Cardiac Patients.
abstract: BACKGROUND
  In patients with major comorbidities undergoing complex cardiothoracic surgery, incision management is critical. This retrospective review evaluated negative pressure over closed sternal incisions in cardiac patients with multiple comorbidities within 30 days post-median sternotomy.
  
  
  METHODS
  Records of post-sternotomy patients treated with Prevena™ Incision Management System (KCI, an Acelity company, San Antonio, TX), a closed incision negative pressure therapy (ciNPT), were reviewed from September 2010 through September 2014. Data collected included demographics, major comorbidities, types of surgery, relevant medical history, incision length, therapy duration, time to follow-up, and incision complications. Descriptive statistics were computed for continuous variables, frequency, and percentages for categorical variables.
  
  
  RESULTS
  Twenty-seven patients were treated with ciNPT between September 2010 and September 2014. The mean patient age was 62.5 (SD 7.9), and the mean body mass index (BMI) was 38.5 (SD 4.4) kg/m(2). Risk factors included obesity (BMI ≥ 30 kg/m(2), 27/27; 100%), diabetes (25/27; 92.6%), hypertension (16/27; 59.3%), and 20/27 patients (74%) had ≥ 5 comorbidities. Mean ciNPT duration was 5.6 (SD 0.9) days. Within 30 days post-surgery, 21/27 (77.8%) patients had intact incisions with good reapproximation. Two patients experienced minor dehiscences; four cases of superficial cellulitis were treated and resolved. One patient with a dehiscence was readmitted for intravenous antibiotics and five patients were managed successfully with antibiotics as outpatients. All patients had intact incisions with good skin approximation at final follow-up.
  
  
  CONCLUSIONS
  In this retrospective study of post-sternotomy patients at high risk of developing complications, ciNPT over closed sternal incisions resulted in favorable outcomes within 30 days of surgery.
authors.affiliation: Director of CV Surgery Outreach & Structural Heart Program, Centennial Heart and Vascular Center.
authors.forename: V Sreenath Seenu
authors.initials: VS
authors.lastname: Reddy
keywords: negative pressure wound therapy; npwt; prevena; sternal dehiscence; sternal wound infections