Unfortunately, in patients on ECMO, bleeding mostly derives from a mismatch of coagulation and fibrinolysis that makes it impossible to obtain surgical control of the resulting hemorrhagic state. Once the negative pressure is applied, the vacuum effect makes the sponge rigid, stabilizing the sternum to the desired distance. In fact, in patients with hemodynamic impairment because of sternal closure, it is sufficient to shape the VAC sponge to the required width to achieve the desired degree of sternal approximation and place it between the sternal edges.
It has proven effective in removing blood excess, keeping the barrier effect for a long time, and increasing the stability of the divided sternum (4).
To accomplish this, a VAC sponge is added. This pressure, together with surgical sponges, creates a homeostatic barrier, which improves hemodynamic stability and the restoration of coagulative balance. As a result, the event of uncontrollable postoperative bleeding is usually managed by packing the sternum and mediastinal tissues with gauze.Īdding a sump chest tube allows application of negative pressure to the mediastinum.
Negative pressure wound therapy vac skin#
Use of adhesive drape film is easily detached by active bleeding with the risks of damaging the skin through repeated reexplorations and loss of sterility. Direct skin closure is often not possible. Various methods for maintaining the sternum open have been used, including direct skin approximation, mediastinal packing, and adhesive membrane coverage (3). Leaving the sternotomy open turns out to be of paramount importance when cardiac function is reduced and the heart is edematous after a long operation (2). Indeed, the rationale for leaving the chest open is to treat hemodynamic compromise after cardiac surgery and uncontrolled coagulopathy. However, re-exploration for bleeding is associated with a prolonged hospital stay, increased complications such as sternal wound infection and renal impairment, and consequently increased hospitalization costs.ĭelayed sternal closure was first described in 1975 by Riahi and colleagues (1) to avoid hemodynamic compromise resulting from sternal closure. Once the alterations have been corrected and satisfied with the surgical hemostasis, the sternum can be closed. The first step is carried out by the anesthesiologist, who proceeds with the evaluation of thromboelastography and coagulation profile tests. Very often the surgeon wonders what should be done: Continue with hemostasis? Try to close the sternum? Leave the sternum open? All cardiac surgeons have found themselves spending several hours in the operating room for hemostasis, in particular after complex interventions such as aortic dissection and aortic arch replacement with deep hypothermia.
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