Incisional negative pressure wound therapy (INPWT) in the prevention and treatment of post-sternotomy mediastinitis

Deep sternal wound infection (DSWI) occurs in 1-5% of all patients undergoing median sternotomy, with an incidence of 30-40% in case of high risk patients. DSWI greatly increases both morbidity and mortality, with much pain and discomfort for the patient. Recently, many approaches have been reported to reduce the risk of DSWI. Negative Pressure Wound Therapy (NPWT) is classically applied after surgical debridement to improve the microcirculation conditions in the wounds. Incisional negative pressure wound therapy (INPWT) is a novel indication consists in the application of negative pressure on wounds closed by primary intention. This technique improves wound healing through enhanced local perfusion, angiogenesis and granulation tissue formation. This study aims to investigate the impact of the application of INPWT in the prevention and in the treatment of post-sternotomy mediastinitis. Patients undergoing cardiac surgery and considered at high risk of DWSI were included. A simple 1:1 randomization was used to allocate patients into Prev-T group (with application of INPWT after the surgery) or Prev-C group (use a standard medication after surgery). A total of 200 patients undergoing cardiac surgery have been included and randomized into Prev-T (100) and Prev-C (100) group. At the time of discharge, the incidence of wound dehiscence was 0% in the treatment group and 2% (p-value = 0.497). However, at the 30-day follow-up, the incidence of dehiscence increased to 5% in the treatment group and 14% in the control group, representing a statistically significant difference (p-value = 0.030). Those data suggest a reduction of 60% in DSWI, echoing study design and confirming operative hypothesis. Our study confirmed the efficacy of incisional Negative Pressure Wound Therapy (iNPWT) to wounds with a high risk of complications; it appears to be effective at multiple levels and can be adapted for use across various types of post-surgical wounds We endeavored to formulate a treatment algorithm that encompasses all aspects of the triad involved in sternal wound repair. The goal is to enhance the quality of life for patients and implement targeted therapeutic strategies tailored to each individual.