THE IMPACT OF PROLONGED RETRACTOR USE ON EARLY POSTOPERATIVE SOFT TISSUE ISCHEMIA IN STERNOTOMY WOUNDS AND STRATEGIES FOR ITS PREVENTION

Introduction. Sternotomy is a commonly employed in cardiac surgery; however, the prolonged use of a sternal retractor to open the chest may lead to ischemic complications affecting the surrounding soft tissues. Vascular compression during retraction can impair local blood supply, resulting in tissue hypoxia, necrosis, and even dehiscence of postoperative sutures. Objectives. To evaluate the impact of prolonged applying of a sternal retractor on oxygenation and perfusion levels in the soft tissues of a sternotomy wound, and to develop and assess the effectiveness of preventive strategies aimed at reducing the risk of postoperative ischemia in soft tissues. Materials and methods. The study was conducted at the Poltava Regional Cardiovascular Center. 28 patients were examined after cardiac surgery (aortocoronary bypass and valve interventions), who were divided into control (n=15) and experimental (n=13) groups. In the experimental group, the following preventive measures were applied: periodic loosening of the retractor, use of barrier wipes moistened with warm papaverine solution, and periodic moistening of soft tissues. The oxygen level and perfusion index were determined using a pulse oximeter with a dermal sensor. Results and discussion. In the control group, the oxygen level significantly decreased after surgery in all thirds of the wound (p < 0.05). In the experimental group, a significant decrease in oxygen level was observed only in the middle and lower third (p < 0.05), while in the upper third the changes were insignificant, p = 0.19 (p > 0.05), which indicates the effectiveness of the preventive measures at this stage of comparison. Analysis of the obtained findings showed that after surgery, the oxygenation and perfusion levels were significantly higher in the experimental group compared to the control in all zones (p < 0.05), but were still lower than the initial values. In the control group after surgery, the oxygen level decreased on average in all three zones, the lowest values were recorded in the lower third (86.87 ± 1.19% versus 95.87 ± 1.19% before surgery). The perfusion index also declined significantly (to 2.73 ± 0.18% in the lower third). In the experimental group, the oxygenation level after the intervention remained higher on average (for example, in the middle third 92.77 ± 0.83% versus 88.47 ± 1.06% in the control group), and the perfusion index lowered less significantly (to 3.15 ± 0.11% in the lower third). Thus, the miner changes were noted in the upper third, and the major in the lower one. Complications associated with tissue ischemia were observed in 33.3% of cases in the control group versus 7.7% of cases in the experimental group. Conclusion. Prolonged use of a sternal retractor leads to a decline in oxygenation and perfusion levels in the soft tissues of the sternotomy wound. The proposed preventive strategies have been found out to improve oxygenation and perfusion indices. The most vulnerable area is the lower third of the wound, where the risk of ischemic complications is the highest.