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Topical negative pressure therapy of a sternotomy wound increases sternal fluid content but does not affect internal thoracic artery blood flow: assessment using magnetic resonance imaging.

Petzina, Rainer LU ; Ugander, Martin LU ; Gustafsson, Lotta LU ; Engblom, Henrik LU ; Hetzer, Roland; Arheden, Håkan LU ; Ingemansson, Richard LU and Malmsjö, Malin LU (2008) In The Journal of thoracic and cardiovascular surgery 135(5). p.1007-1013
Abstract
OBJECTIVE: Topical negative pressure therapy has excellent healing effects in poststernotomy mediastinitis. Topical negative pressure therapy reduces bacterial counts, increases wound edge microvascular blood flow and granulation tissue formation, and facilitates healing. No study has yet been performed to examine the effect of topical negative pressure on the blood and fluid content in the sternal bone marrow, which is a crucial component in osteitis. METHODS: Eight pigs underwent median sternotomy, left internal thoracic artery harvesting, followed by topical negative pressure treatment. Magnetic resonance imaging was used to quantify both tissue fluid and/or blood content (T2-weighted short tau inversion recovery [T2-STIR]) and internal... (More)
OBJECTIVE: Topical negative pressure therapy has excellent healing effects in poststernotomy mediastinitis. Topical negative pressure therapy reduces bacterial counts, increases wound edge microvascular blood flow and granulation tissue formation, and facilitates healing. No study has yet been performed to examine the effect of topical negative pressure on the blood and fluid content in the sternal bone marrow, which is a crucial component in osteitis. METHODS: Eight pigs underwent median sternotomy, left internal thoracic artery harvesting, followed by topical negative pressure treatment. Magnetic resonance imaging was used to quantify both tissue fluid and/or blood content (T2-weighted short tau inversion recovery [T2-STIR]) and internal thoracic artery blood flow (flow quantification). RESULTS: Before application of topical negative pressure, the T2-STIR signal intensity ratio was lower for the left than for the right hemisternum (left, 1.3; right, 2.6), indicating lower levels of tissue fluid content on the left, devascularized side. On application of topical negative pressure, the T2-STIR signal intensity ratio increased immediately for both the sternal bone and the pectoral muscle (left hemisternum after 4 minutes of topical negative pressure: 2.3), leveled off after 4 minutes, and remained unchanged for the ensuing 40 minutes, suggesting movement of fluid and/or blood into the tissue of the wound edge. Topical negative pressure did not affect blood flow in the right internal thoracic artery. CONCLUSIONS: T2-STIR measurements show that topical negative pressure increases sternotomy wound edge tissue fluid and/or blood content. Topical negative pressure creates a pressure gradient that presumably draws fluid from the surrounding tissue to the sternal wound edge and into the vacuum source. This "endogenous drainage" may be one possible mechanism by which osteitis is resolved by topical negative pressure in poststernotomy mediastinitis. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of thoracic and cardiovascular surgery
volume
135
issue
5
pages
1007 - 1013
publisher
Mosby
external identifiers
  • wos:000255512800007
  • pmid:18455577
  • scopus:42949120596
ISSN
1097-685X
DOI
10.1016/j.jtcvs.2007.09.070
language
English
LU publication?
yes
id
bfd5b3de-20ff-4dea-9551-d38824fe727e (old id 1154577)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18455577?dopt=Abstract
date added to LUP
2008-06-04 11:47:34
date last changed
2017-09-17 08:35:39
@article{bfd5b3de-20ff-4dea-9551-d38824fe727e,
  abstract     = {OBJECTIVE: Topical negative pressure therapy has excellent healing effects in poststernotomy mediastinitis. Topical negative pressure therapy reduces bacterial counts, increases wound edge microvascular blood flow and granulation tissue formation, and facilitates healing. No study has yet been performed to examine the effect of topical negative pressure on the blood and fluid content in the sternal bone marrow, which is a crucial component in osteitis. METHODS: Eight pigs underwent median sternotomy, left internal thoracic artery harvesting, followed by topical negative pressure treatment. Magnetic resonance imaging was used to quantify both tissue fluid and/or blood content (T2-weighted short tau inversion recovery [T2-STIR]) and internal thoracic artery blood flow (flow quantification). RESULTS: Before application of topical negative pressure, the T2-STIR signal intensity ratio was lower for the left than for the right hemisternum (left, 1.3; right, 2.6), indicating lower levels of tissue fluid content on the left, devascularized side. On application of topical negative pressure, the T2-STIR signal intensity ratio increased immediately for both the sternal bone and the pectoral muscle (left hemisternum after 4 minutes of topical negative pressure: 2.3), leveled off after 4 minutes, and remained unchanged for the ensuing 40 minutes, suggesting movement of fluid and/or blood into the tissue of the wound edge. Topical negative pressure did not affect blood flow in the right internal thoracic artery. CONCLUSIONS: T2-STIR measurements show that topical negative pressure increases sternotomy wound edge tissue fluid and/or blood content. Topical negative pressure creates a pressure gradient that presumably draws fluid from the surrounding tissue to the sternal wound edge and into the vacuum source. This "endogenous drainage" may be one possible mechanism by which osteitis is resolved by topical negative pressure in poststernotomy mediastinitis.},
  author       = {Petzina, Rainer and Ugander, Martin and Gustafsson, Lotta and Engblom, Henrik and Hetzer, Roland and Arheden, Håkan and Ingemansson, Richard and Malmsjö, Malin},
  issn         = {1097-685X},
  language     = {eng},
  number       = {5},
  pages        = {1007--1013},
  publisher    = {Mosby},
  series       = {The Journal of thoracic and cardiovascular surgery},
  title        = {Topical negative pressure therapy of a sternotomy wound increases sternal fluid content but does not affect internal thoracic artery blood flow: assessment using magnetic resonance imaging.},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2007.09.070},
  volume       = {135},
  year         = {2008},
}