ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fleck, T. M.
Right arrow Articles by Grabenwoger, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fleck, T. M.
Right arrow Articles by Grabenwoger, M.
Related Collections
Right arrow Cardiac - other

Ann Thorac Surg 2003;76:974
© 2003 The Society of Thoracic Surgeons

Correspondence

Reply

Tatjana M. Fleck, MDa, Martin Grabenwoger, MDa

a Department of Cardiothoracic Surgery, University of Vienna, AKH Vienna, Leitstelle 20A, Währinger Gürtel 18-20, 1090 Vienna, Austria

e-mail: t9204604{at}hotmail.com
e-mail: t9204604{at}hotmail.com

To the Editor:

We thank Abu-Omar and colleagues for their thoughtful comments regarding the rare but potentially devastating complication of right ventricular rupture during high-pressure suction therapy for poststernotomy mediastinitis. To date, we have successfully treated 25 patients with the vacuum-assisted wound closure system without encountering this problem.

However, certain precautions are routinely undertaken to prevent such complications of high-pressure suction therapy. A small towel is fitted under and between the two halves of the sternum to prevent shearing forces between the sternal edges and the beating heart and between the sternal halves (Fig 1). Direct contact between the sternal edges and the underlying structures is also prevented. We suggest use of two medium sponges connected with a Y piece for more uniform distribution of suction over the entire wound surface. This enhances stabilization of the sternum and facilitates mobilization of the patient [1].



View larger version (139K):
[in this window]
[in a new window]
  		Fig 1. To avoid complications of high-pressure suction therapy, a small towel is fitted under and between the two halves of the sternum to prevent shear between the sternal edges and the beating heart and between the sternal halves. This also prevents direct contact between the sternal edges and the underlying structures.

 
We are concerned about the suggestion to reduce the amount of suction to 70 mm Hg. In addition to decreasing the evacuation of wound exudates and decelerating the progress of granulation tissue growth, the reduced target pressure might lead to instability of the chest wall and thus promote shear between the sternal edges with an increased risk of right ventricular laceration.

We think it unusual that damage to the ventricular wall was possible with the technique diagrammed in Figure 1 in a previous report by Catarino and associates [2]. The foam fills the space between the sternal edges and stiffens with the negative pressure, and thereby prevents movement of the sternum.

In conclusion, to prevent ventricular rupture, we recommend the use of a small towel fitted between and under the sternal edges for protection of the heart.

References

  1. Fleck T.M., Fleck M., Moidl R., et al. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg 2002;74:1596-1600.[Abstract/Free Full Text]
  2. Catarino P.A., Chamberlain M.H., Wright N.C., et al. High-pressure suction drainage via a polyurethane foam in the management of poststernotomy mediastinitis. Ann Thorac Surg 2000;70:1891-1895.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
U. Fuchs, A. Zittermann, B. Stuettgen, A. Groening, K. Minami, and R. Koerfer
Clinical Outcome of Patients With Deep Sternal Wound Infection Managed by Vacuum-Assisted Closure Compared to Conventional Therapy With Open Packing: A Retrospective Analysis
Ann. Thorac. Surg., February 1, 2005; 79(2): 526 - 531.
[Abstract] [Full Text] [PDF]

Home page
 Interact CardioVasc Thorac SurgHome page
J. Sjogren, R. Gustafsson, A. Wackenfors, M. Malmsjo, L. Algotsson, and R. Ingemansson
Effects of vacuum-assisted closure on central hemodynamics in a sternotomy wound model
Interact CardioVasc Thorac Surg, December 1, 2004; 3(4): 666 - 671.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
W. H. Merrill, S. A. Akhter, R. K. Wolf, E. W. Schneeberger, and J. B. Flege Jr
Simplified treatment of postoperative mediastinitis
Ann. Thorac. Surg., August 1, 2004; 78(2): 608 - 612.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fleck, T. M.
Right arrow Articles by Grabenwoger, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fleck, T. M.
Right arrow Articles by Grabenwoger, M.
Related Collections
Right arrow Cardiac - other

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS