From the Guidelines
The next step in managing wound dehiscence after CABG surgery performed 3 weeks ago is to implement local wound care with daily cleaning and appropriate dressings, while avoiding activities that create tension on the wound. Given the patient is 3 weeks post-CABG, it's crucial to consider the healing process of the surgical incision, as noted in the study by 1, which suggests that chest and leg wounds usually require 4 to 6 weeks for healing. Key considerations in managing the wound dehiscence include:
- Local wound care with daily cleaning using sterile saline or a mild antiseptic solution
- Application of appropriate dressings, such as hydrocolloid or foam dressings for moist wound healing, changed every 2-3 days
- Monitoring for signs of infection and obtaining wound cultures if necessary, followed by empiric antibiotics
- Nutritional support with a protein intake of at least 1.2-1.5g/kg/day to promote healing
- Avoiding activities that create tension on the wound, such as heavy lifting or excessive arm movements, as upper body exercises that cause sternal tension should be avoided for up to 3 months after surgery, as recommended by 1. Close monitoring is essential with follow-up within 2-3 days to assess healing progress and prevent complications.
From the Research
Management of Wound Dehiscence after CABG
The management of wound dehiscence after coronary artery bypass grafting (CABG) is a critical issue, as it can lead to significant morbidity and mortality.
- The next step in management for wound dehiscence (surface level suture) after a CABG performed 3 weeks ago may involve surgical debridement, also known as "wash out", followed by antibiotic therapy 2.
- Vacuum-assisted closure (VAC) therapy has been shown to be effective in managing sternal wound dehiscence, with reduced mortality, incidence of complications, and need for surgical procedures 3, 4.
- VAC therapy has been compared to traditional closed drainage (TCD) with irrigation, and has been found to have a lower rate of failure of sternal wound healing or re-infection 4.
- The use of VAC therapy has been recommended as an adjunctive therapy for chronic, difficult-to-heal wounds, including those that occur after CABG 5.
Considerations for Management
- The management of wound dehiscence after CABG should take into account the individual patient's risk factors, such as age, comorbidities, and previous treatments 6.
- The choice of management strategy should be based on the severity of the wound dehiscence, the presence of infection, and the patient's overall health status 2, 3, 4.
- A multidisciplinary approach, involving surgeons, wound care specialists, and other healthcare professionals, may be necessary to optimize the management of wound dehiscence after CABG 5.