Low-Pressure negative pressure wound therapy for refractory poststernotomy wound dehiscence with sternal exposure in a neonate: a case report

Severe poststernotomy wound dehiscence (PSWD) complicated by deep tissue necrosis is a life-threatening condition in neonates following cardiac surgery. While negative pressure wound therapy (NPWT) is widely utilized in adult cardiothoracic surgery, pediatric consensus remains limited. Specifically, establishing safe suction parameters for neonates—who face high risks of hemodynamic compromise and epidermal stripping—remains a major clinical challenge. We report a 2830 g female neonate who developed refractory PSWD 20 days after median sternotomy for complex congenital heart disease. Following the failure of primary wound healing, sutures were removed to expose a deeply dehisced cavity characterized by 100% necrotic base coverage, heavy serosanguinous exudate, and a 2 cm undermining tract reaching the sternum. To bridge this open, compromised wound with sternal exposure toward delayed secondary closure, we established a Stepwise Bridge Strategy: (1) bedside wound bed preparation with mechanical debridement and polyhexamethylene biguanide (PHMB) for biofilm disruption; (2) low-pressure NPWT (− 25 to − 50 mmHg) applied over a non-cytotoxic contact layer; and (3) delayed bedside wound approximation. After 12 days of NPWT, healthy granulation tissue completely covered the sternum. Complete wound closure was achieved on postoperative day 60, and an 18-month follow-up confirmed normal thoracic skeletal development. For neonates presenting with severe PSWD following primary closure failure, a stepwise bridge strategy utilizing customized low-pressure NPWT serves as a safe, feasible bedside modality to prepare the wound bed for secondary approximation without compromising cardiovascular or skeletal physiology. However, these observations are based on a single case and further studies are needed to establish safety profiles.