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Ventricular Assist Device-Associated Sternal Wounds: A Systematic Literature Review on Reconstructive Management
Robert Clark BS, Marco Swanson MD, Anand Kumar MD, Kyle Lineberry MD
Case Western / University Hospitals
2020-02-14
Presenter: Robert Clark BS
Affidavit:
All work on this project represents the original work of the resident.
Director Name: Edward Davidson MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
As the population of patients with Left Ventricular Assist Devices (LVAD) increases, the plastic surgeon continues to play an increasing role in management of associated wounds. This study aims to provide a systematic literature review of the current surgical management of LVAD-related sternal wounds.
Methods:
The EMBASE and MEDLINE databases were systematically reviewed following the PRISMA guidelines. Primary studies on ventricular assist devices, sternal wound, and reconstruction were included. Publications in languages other than English were excluded.
Results:
26 articles were identified: 11 case reports, 9 retrospective studies, and 6 case series. A total of 135 patients with mean age 53±15 years and 17% female were found. Devices reported were Heartmate-II 41%, Heartware-VAD 11%, Heartmate-I 4%, Other 10%, and unreported 40%, with some patients having multiple devices. Mean time from implant to reported infection was about 7.03 months. Infections reported were pocket-related 46%, driveline-related 24%, mediastinitis 15%, blood 9%, other 4%, unspecified 5%. Among the surgical strategies, 12 different flap types were reported, most common: omental 34%, rectus abdominus 24%, and pectoralis major 10%. Negative pressure wound therapy (NPWT) was utilized in 15 studies, one utilizing irrigation NPWT.
Conclusion:
The current literature on surgical management of LVAD-related sternal wounds is scarce and limited. There is no consensus or accepted surgical algorithm for reconstruction of these wounds. Data reporting on LVAD-related sternal wound management needs to be more standardized and consistent in order to provide more definitive guidance to the reconstructive surgeon.
