Management of closed sternal incision after bilateral internal thoracic artery grafting with a single-use negative pressure system

Single-use, closed incision management (CIM) systems offer a practical means of delivering negative pressure wound therapy to patients. This prospective study evaluates the Prevena Therapy system in a cohort of coronary patients at high risk of deep sternal wound infection (DSWI). Fifty-three consecutive patients undergoing bilateral internal thoracic artery (BITA) grafting were preoperatively elected for CIM with the Prevena Therapy system, which was applied immediately after surgery. The actual rate of DSWI in these patients was compared with the expected risk of DSWI according to two scoring systems specifically created to predict either DSWI after BITA grafting (Gatti score) or major infections after cardiac surgery (Fowler score). The actual rate of DSWI was lower than the expected risk of DSWI by the Gatti score (3.8 vs. 5.8%, p=0.047) but higher than by the Fowler score (2.3%, p=0.069). However, while the Gatti score showed very good calibration ((2)=4.8, p=0.69) and discriminatory power (area under the receiver-operating characteristic curve 0.838), the Fowler score showed discrete calibration ((2)=10.5, p=0.23) and low discriminatory power (area under the receiver-operating characteristic curve 0.608). Single-use CIM systems appear to be useful to reduce the risk of DSWI after BITA grafting. More studies have to be performed to make stronger this finding.