Problems of wound treatment after cardiac surgery operation: Bioactive therapy by Traumacel Biodress

12. 7. 2011

Problems of wound treatment after cardiac surgery operation: Bioactive therapy by Traumastem Biodress

MUDr. Vlastimil Kubíček, MUDr. Marek Pojar University Hospital Hradec Králové, Cardiac Surgery Clinic

Sumarry: Operating wound healing disorder represents a serious complication of surgical intervention, prolongs patient´s hos­pitalization and requires more demanding nursery care. Our experience confirmed that therapy with Traumastem Biodress accelerates dehiscent wounds healing due to its ability of tissue remodelling.

Operating wound healing disorders in cardiac surgery: With cardio surgery patients, disorders of operating wound healing appear in the place of sternotomy, after venous graft collection on lower limbs or collection arterial grafts on upper limbs. According to data from National Cardiac Surgery Register, the early infection in 2007 with 4% of patients occurred in our workplace, 2,9% of it was a serious infection. The most serious complication with relative high mortality represents an origin of acute mediastinitis with septic shock development, often resulting in multiorganic failure and a possibility of prostethic endocarditis origin. Less serious disorders of operating wound healing negatively effect a quality of patient’s life after operation, limit the rehabilitation possibilities after operation and can result in long-term patient´s inva­lidity. Therefore it is very important to watch effective methods of their treatment.

New possibility in wound treatment: bioactive therapy: When healing wounds per secundam, we follow general principles of wet therapy. In the last 6 month we successfully started using of resorbable dressing Traumacel Biodress on the basis of hydrogen-calcium salt of oxidized cellulose, which induces and accelerates the whole healing process due to its bioactive effect, based on the ability to inhibit Matrix Methaloproteinasis (MMPs). There are enzymes produced by granulocytes, keratinocytes and fibroblasts involved in tissue remodelling, wounds healing and angiogenesis. Their concentration with chronic wounds is many times higher than with acute wounds. Traumacel Biodress increases the quantity of growth factors in the wound, activates fibroblasts and reduces bacterial load. Thereby comes to clearing and revitalizing of the wound base and starting of granulation and epithelisation process. The dressing is hypo allergic and biodegradable – it is absorbed in the wound within 1 – 3 days, depending on the wound character and the volume of exudate. Thanks to its haemostatic effect it is possible to use it even for haemostasia of chronic wounds. Laboratory test proved bactericidal effect against gram-positive and gram-negative strains Staphylococcus aureus MRSA, Streptococcus pyogenes, Streptococcus beta-haemol. non A non B and bacteriostatic effect against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus hirae a Proteus vulgaris strains As it is resorbable material which can be left in the wound for 1 – 3 days without any intervention, there is no risk of wound traumatisation and, compared with standard therapy, also the costs on treatment are significantly lower. Further, the risk of infection bringing is decreased and, as the casuistry bellow shows, the time of patient´s hos­pitalization is remarkably shorter.

Bioactive healing of a dehiscent wound: We introduce here casuistry of a patient after replacement of aortal valve, where the post-operation course was complicated by wound dehiscence. After application of Traumacel Biodress came after 2 days to granulation of the wound and suppression of the infection, thus after 9 days the wound was healed to that stage that it was possible to perform resuture and discharge the patient from a hospital to home care.

State before starting the treatment: A 76-year-old client with calcified aortic stenosis was indicated to the aortic valve replacement by prothesis. After preparation we performed operation in extracorporeal circulation, removed calcified aortic stenosis and implanted aortic bioprothesis Soprano No. 20 instead. During postoperative stage, light amented delirious conditions occurred with ze patient. The state improved within 72 hours, the patient was afebrile, with stable circulation. With respect to the diagnosis – state after aortic valve replacement – was the patient provided with antibiotics (Augmentin) during the time of dehiscent wound treatment.

Wound healing development: On 8th postoperative day, a reddening in the wound area occurred – sternotomy. A dressing was strongly seeped with serosanguinolent secretion. 15 cm of the wound in the middle of sternotomy is dehiscent, with furred, whitish and slightly necrotic borders. After intradermal suture removal we compressed Betadine. The wound is dehiscent in extent of skin and subcutis, of length 15cm, 2 cm in depth, with minimal secretion (Fig.1). A smear of K+ C (result in 48 hours negative). Further a debridement and compression of the wound with Betadine solution were performed. On 10th postoperative day we started therapy with Traumacel Biodress (Fig.2). In the course of therapy we repeatedly applied Traumacel Biodress on 10., 12., and 16. day after operation, always after moistening with physiological saline. It emerged that it was more advantageous to adapt Traumacel Biodress to the wound size so that it did not overlap the borders because it is not absorbed outside the wound. After that we covered Traumacel Biodress by Inadine and fixed with transparent sticking film in order to be able to watch therapeutic effect. After 48 hours of therapy is the dressing partly biodegraded. Even consumption of Inadine is obvious – see the decolorized part of the dressing (Fig. 3). Remaining part of the dressing we mechanically removed from the wound, by moist pad with boric acid solution. Already after 2 days, fresh granulation is noticeable in the wound (Fig.4) 16th day after operation, after third application of Traumacel Biodress (Fig. 5) is the wound without any secretion (Fig.6). After mechanical clearing by pad with boric acid solution, the noticeable granulation and epithelisation is visible in the wound (Fig.7) 19th day of hospitalization is the wound healed and it is possible to perform resuture by single stitches, under local anaesthesia. The second day after suture is the wound calm; the patient was discharged to home care and transferred to general practitioner’s ca­re. Conclusion: Our experience confirmed that application of Traumacel Biodress remarkably accelerates the healing of dehiscent wounds. It is able to reduce bacterial load and influence metabolic and biochemical processes running in the wound. Thanks to this comes to improving of patient´s quality of life, reduction of hospitalization and also to reduction of costs on treatment of wound healing disorder. Currently we are looking for other possibilities of using Traumacel Biodress – e.g. we try to use it in combination with V.A.C. therapy. We presume that it is possible to use Traumacel Biodress for treatment of wounds healing per secundam in all fields of surgery.

Literature 1/ Ulrichová, J., Franková, J: Influence of Traumacel Biodress on MMPs The Faculty of Medicine, Palacký University Olomouc, Institut of Medical Chemisrtry and Biochemistry 2008. 2/ Vašků, V., Slonková, V.: Using of oxidized cellulose in therapy of chronic ulcerations of venous origin (clinical study) St.Anne´s Uni­versity Hospital Brno 2008 .