Preventing Sternal Wound Dehiscence: A Guide to a Safer Recovery

Recovering from heart surgery can be a long and challenging process, particularly during the immediate postoperative period. While some patients experience a relatively smooth recovery, others may encounter complications, such as sternal wound dehiscence—the reopening of the sternal wound.

Understanding Sternal Wound Dehiscence

Sternal wound dehiscence is a serious postoperative condition that can be life-threatening. It occurs in approximately 2.3% of cardiac or thoracic surgery patients, leading to prolonged recovery and increased healthcare costs. Recognizing the risks and following proper preventive measures are crucial to minimize the occurrence of this complication.

What to Know About Sternal Wound Dehiscence

After cardiac surgery, the sternum requires specialized care and protection. The sternum's vulnerability to complications, such as sternal dehiscence, underscores the importance of following proper care guidelines and utilizing sternum support for optimal healing.

Sternal dehiscence refers to the complete separation of the sternum into two parts, often associated with sternum wound infections and specific types of cardiac surgeries. While females face a greater risk, both genders can experience sternal dehiscence due to factors such as smoking, obesity, multiple operations, and more.

Key facts about sternal dehiscence include:

• Side effects may include prolonged pain, fever, and unusual sounds emanating from the moving sternum.
• Treatment typically involves repairing muscles or bones, along with a targeted antibiotic regimen.
• Although the risks associated with sternal dehiscence are significant, mortality rates have been declining due to advancements in medical practices.

The Role of Sternum Support

Fortunately, sternal dehiscence is not inevitable. With proper care and the use of sternum support devices, patients can protect their chest and wound, promoting faster and safer healing. Sternum support enables patients to move, breathe, and cough comfortably without disturbing the sternum, minimizing the risk of complications like sternal dehiscence.

Sternal support devices are typically used in hospitals and sent home with patients to ensure continuous and effective support. By safeguarding both the wound and the sternum throughout the healing process, these devices significantly reduce the risk of sternal dehiscence and other painful and dangerous complications.

The Evolution of Sternal Dehiscence Management

The midline sternotomy procedure introduced the risk of sternum infection and subsequent dehiscence. Initially, open drainage and debridement with packing were employed to treat sternal dehiscence. However, this approach led to complications such as graft exposure, wound margin desiccation, osteomyelitis, and even mortality.

In 1963, Shucker and Mandelbaum introduced closed management with catheter-antibiotic irrigation, which resulted in improved survival rates. Subsequent advancements, including wide debridement, muscle and mucocutaneous flap translation, and the use of vascularized regional tissue, further enhanced outcomes by promoting greater blood flow, obliterating dead space, and reducing infection.

While soft tissue flaps proved effective, they didn't address bony sternum repair, which could lead to pain, paradoxical motion, and impaired pulmonary function. However, vacuum-assisted closure devices bridged the gap between debridement and reconstruction, offering a solution that improved patient outcomes.

Today, various surgical strategies, including the use of flaps and sternal clamps, continue to refine the management of sternal dehiscence. Reconstruction techniques aim to avoid the need for bony sternal repair, ensuring better pain management and overall recovery.

Causes of Sternal Dehiscence

Several factors can contribute to sternal wound dehiscence, including:

• Inadequate undermining of the wound during surgery.
• Excessive tension on the wound edges due to lifting or straining.
• Location of the wound in a highly mobile or high-tension area.
• Risk factors like obesity, smoking, and surgical errors.

Signs to Watch For

Patients, especially those with additional risk factors, should be vigilant for warning signs of sternal dehiscence. Early detection can prevent more serious sternal wound complications. Common symptoms include:

• Swelling, pain, or inflammation at the wound site.
• Fever.
• Sudden opening at the wound site, including broken sutures and a lack of usual healing signs.
• Drainage.

Preventing Sternal Wound Dehiscence

Recovering from heart surgery requires patience and careful attention to avoid complications. To prevent sternal wound dehiscence, consider the following preventive measures:

• Bracing the Wound: Using a sternum support device, like the Heart Hugger, during activities, sneezing, coughing, or vomiting provides crucial protection and minimizes the risk of dehiscence.
• Employing Proper Incision Care: Adhere to your physician's wound care instructions, including cleaning and proper bandaging techniques, to prevent complications.
• Avoiding Lifting: Follow your doctor's restrictions on lifting heavy objects, as excessive strain on a fresh wound can increase the risk of sternal wound dehiscence.

By taking these proactive steps, you can significantly reduce the chances of sternal wound dehiscence and promote a smoother and safer recovery process.

The Power of Heart Hugger

Heart Hugger is a proven solution designed to help patients manage pain, protect the sternal closure, and avoid serious wound complications. The device offers unparalleled comfort, pain control, and support during the healing journey. When used in conjunction with a doctor's guidance, Heart Hugger enables cardiac and thoracic surgery patients to heal faster and minimize the risk of complications, including sternal dehiscence.

Healing Well

In addition to sternum support, there are additional factors to consider for a successful recovery:

• Effective Pain Management: Follow your doctor's prescribed pain control plan and take medications as instructed to minimize discomfort.
• Gradual Activity Resumption: Ease back into daily activities following your doctor's recommendations, avoiding strenuous movements and heavy lifting to allow proper healing.
• Maintain a Healthy Diet: Consume foods that promote heart health and support a healthy immune system. Limit intake of fats, cholesterol, sugar, and salt while enjoying desserts in moderation.

Conclusion

Preventing sternal wound dehiscence requires proactive measures and proper support throughout the recovery process. By employing sternum support devices like Heart Hugger, following preventive steps, and maintaining overall well-being, you can ensure a safer and more successful recovery after heart surgery. Remember, you are not alone on this journey – seek support from Heart Hugger and healthcare professionals to optimize your healing process and minimize the risk of complications.