Preventing Sternal Wound Dehiscence

Heart surgery can have a long and arduous recovery process that immediately follows the procedure. For some, this recovery process is easier than expected and their health returns after a few weeks. For others, there are complications that are associated with recovery. One of these complications is known as sternal wound dehiscence, or the reopening of the sternal wound. 

Wound dehiscence is a serious postoperative condition that can be life-threatening. Wound complications following surgery occur in approximately 2.3% of cardiac or thoracic surgery patients. While most patients will not experience serious wound dehiscence, it's important to understand and follow the proper steps to prevent its occurrence.

What To Know About Sternal Wound Dehiscence

After cardiac surgery, the sternum needs special care. Protecting it is one of the biggest and most important steps in the healing process--and that's because the risks are especially high. One possible complication is sternal dehiscence, which, while painful and dangerous, can be avoided with the help of proper care and sternum support.

Sternal dehiscence occurs when the sternum separates completely into two parts. It is sometimes related to infections of sternum wounds, and is linked specifically to certain types of cardiac surgery. Females are at greater risk than males, but there are risk factors that increase the chances of sternal dehiscence in both genders, including smoking, obesity, multiple operations, and more. 

The most important things to know about sternal dehiscence are:

• The side effects include pain lasting more than a month, fever, and strange sounds from the moving sternum
• Treatment involves repairing muscles or bones along with a round of specific antibiotics
• The danger related to sternal dehiscence is considerable, but mortality rates are constantly dropping thanks to modern medicinal practices

Sternum Support can help

The good news is that sternal dehiscence isn't a given. With proper care and the use of sternum support devices, the chest and the wound can both be protected. Support allows the patient to move, breathe, and cough comfortably, all without disturbing the sternum, which means that healing can be quicker and safer than ever. 

Generally, sternum support devices are first used in the hospital, and then taken home with the patient in order to encourage the best possible support. This means that both the wound and the sternum are protected throughout the healing process, which minimizes the risk of sternal dehiscence as well as other painful and dangerous complications.

History Of Sternal Dehiscence

The midline sternotomy made its entrance into the clinical world, but not without complications. Sternal infection was on the rise. Sternal dehiscence was treated with open drainage and debridement with packing. Results included complications like graft exposure, desiccation of wound margins, osteomyelitis, and death. In 1963, Shucker and Mandelbaum introduced closed management with catheter-antibiotic irrigation. Survival rates increased, but they were still pretty slim. With the mortality risks, there was a great desire to discover better wound care.

Changes in Management

First of all, sternal instability was causing mediastinal infections of the wounds. The surgeon must take the time to use the meticulous technique when doing a sternotomy. Proper placement reduces the risks of mediastinitis.

The principles of wide debridement and muscle and mucocutaneous flap translation entered the stage and helped manage infected sternal wounds. In 1976 Lee, et al. introduced the concept of flaps to reduce dead space in the anterior mediastinum. A few years later in 1980 Jurkiewicz continued to improve the management of sternal dehiscence and wound infection by the concept of muscle and mucocutaneous flaps.

The use of vascularized regional tissue meant:

1. Greater blood flow
2. Obliteration of dead space
3. Quicker healing time
4. Less infection

Other flaps have been introduced to help repair chest walls. Finally, the mortality rate dropped to 10%. Things weren't yet perfected, however, and soft tissue flaps don't repair the bony sternum (resulting in pain, paradoxical motion and impaired pulmonary function testing). Vacuum-assisted closure devices provide a solution to bridge the gap between debridement and reconstruction.

Today many surgical strategies are in use, including flaps. Reconstruction is continually being refined to avoid the issue of bony sternal repair. A newer device is the sternal clamp to reduce sternal instability.

Causes of Sternal Dehiscence

So, what causes sternal wound dehiscence? Some of the most common reasons include:

• An inadequate undermining of the wound during surgery.
• Excessive tension on the wound edges caused by lifting or straining.
• Location of the wound is on a highly mobile or high tension area. 
• Risk factors like obesity, smoking, and surgical error.

Signs to Watch For

Patients, especially those with additional risk factors, should be aware of the warning signs of wound dehiscence. Early detection can prevent more serious sternal wound complications. 

Some of the more common symptoms include:

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

Preventing Sternal Wound Dehiscence

It’s important to remember that it takes time to ease back into everyday activities. Refrain from returning to regular exercise routines if they include strenuous movement. Lifting heavy weights can cause excessive tension on wound openings. Holding back from asking for help can also negatively impact your recovery. Enlist the help of one dependable family member or friend in the first week or two. Preventing the sternal wound from opening should be your primary priority and you will benefit from outside help.

Caring for your wound takes form in a couple of different shapes. First, you should properly attend to the area of surgery itself. Your doctor will recommend how to clean and bandage the wound. Next, be prepared to take care of your whole body. This means eating foods that promote heart health and attribute to a healthy immune system. Allow yourself to relax and try not to force yourself to fill a productivity need. Another impactful way to improve recovery is to support your sternum. This can be done with a sternal support device, such as a Heart Hugger. When you sneeze or cough you run the risk of causing damage to your wound closure. A Heart Hugger device will act as a brace and minimize pain.

Additional ways you can prevent sternal wound dehiscence include:

• Bracing the Wound. This is one of the best things a patient can do when recovering from heart surgery to avoid wound dehiscence. The Heart Hugger was invented to act as a brace for the patient during activity, sneezing, coughing, or vomiting. Not only does this help prevent dehiscence, it will also minimize pain.
• Employ Proper Incision Care. Your physician will be able to let you know how to properly care for your wound in order to prevent complications. It is important that you take this advice very seriously, as any complication to surgery is less than ideal. If this includes cleaning the wound as well as bracing every time you need to sneeze or cough, you should be following these instructions.
• Avoid any Lifting. Your doctor may give you restrictions following your surgery, especially within the first few weeks. We always recommend that you follow the advice of your doctor. Lifting objects over five pounds can have a negative effect on a new wound and put you at risk for sternal wound dehiscence. 

Remember to be careful for a few weeks following a major surgery. If employed properly, the Heart Hugger can help prevent sternal wound dehiscence and put you on the right track to recovery.

How Heart Hugger Can Help

Healing is always a journey, which means that it can be a long and winding road sometimes. The good news is that you've got allies on your side. Your doctors and nurses will always give you clear instructions for at-home care, details on what you can and can't do, and explanations for what to expect.

One thing you want to look out for is sternal dehiscence, a condition where the sternum begins to separate. It's a considerable concern in the medical community, but as long as you know what to do, you shouldn't need to worry about it.

The Power of Heart Hugger

The innovative technology of Heart Hugger can help any patient, at any risk level, to avoid complications. Heart Hugger works to provide the sternal support that is so crucial after heart surgery, and this allows patients to move, breathe, and rest easier. The easy-to-use device provides pain control and support, which, in turn, makes it much easier for patients to comply with after-surgery regulations and minimize the risk of complications--especially sternal dehiscence.

Benefits of Heart Hugger

So, how can one simple device do so much for patients after surgery? How can Heart Hugger help patients avoid sternal dehiscence? Here's a quick look!

• Comfort. Often, pain is the number-one factor standing between patients and a well-healed, well-adjusted body. Pain limits motion and discourages patients from doing what they must to heal. Heart Hugger reduces pain by providing support to the sternum, protecting the wound and the patient.
• Limited complications. Heart Hugger can reduce the chances of complications by providing unique care, support, and protection for the sternum and the area of the wound. The device allows movement but limits the damage and pain that can come with after-surgery exercises, thus providing a safer and more protected environment in which the wound can heal.
• Any patient. One of the biggest benefits of Heart Hugger is its ability to adapt to any patient. No matter what size, build, injury, or wound the patient has, Heart Hugger can adapt and continue to offer support and comfort, providing for any patients needs.

Healing well

Sternum support devices like Heart Hugger can help you feel more comfortable and confident during this healing journey--but that's not all you can do. Let’s look again at some of the key tips for keeping your body healthy and happy during recovery.

• Have a plan for pain control. After heart surgery, pain in your chest is a given, especially when you're moving or coughing. (Sternum support devices are a big help here). Remember, the pain should dissipate when you've stopped moving, and it's important that you take your medications exactly as prescribed. This will help minimize complication risk.
• Ease into activity. Your doctor will provide specific guidelines for getting back into daily activities and exercise, but in general, you can expect to be doing normal things -- standing, dressing, sitting at tables -- early on, though you'll want to avoid handling anything over ten pounds for awhile.
• Eat healthy. Diet is a crucial part of healing and can help you avoid sternal dehiscence by giving you the support your body needs. Eat foods low in fat, cholesterol, sugar, and salt, and eat desserts in moderation.

Heart Hugger is a proven solution to help patients manage pain, protect the sternal closure, and avoid serious wound complications. When used in conjunction with a doctor's advice, Heart Hugger helps cardiac and thoracic surgery patients heal faster and prevent after-surgery complications.

You're not alone on your healing journey. For more information on avoiding sternal dehiscence and using sternum support devices, contact Heart Hugger  today!