It is well known that sternal splintage is effective to maintain stable postoperative circulation particularly in neonates and infants with complicated cardiac condition. The heart wound not function appropriately if squeezed by the swollen tissue around. Edema of those tissues as well as that of the myocardium itself does improve usually within several days after surgery. In this respect, delayed chest closure is sensible. Still, this period of days, although short, can be troublesome in terms of wound healing and undesired infection. The surgeons and the nurses are strived to optimize wound care for better outcome.
Film dressings are commonly used to cover the anterior chest. They may not be sticky enough to perfectly separate the wound from the air. In some instances, the dressing could come off the skin, or leachate inside could flow out through a tiny fold of the patch or the dressing. On the other hand, the skin may be irritated with dermatitis caused by adhesive agents.
Karayahesive® is, allegedly, a material coated with hydrocolloid, consisting of two layers: a skin-adhesive layer made from Karaya gum to maintain a moist environment, and an outer layer of polyurethane film to provide a waterproof barrier against the outside the body. On the basis of our experience, this product is flexible and easy to handle. Also, sufficiently self-adhesive. Liquid is absorbed in its hydrophilic layer and turning into gel, which is advantageous for wound management avoiding overflow of leachate from the wound (Fig. 2). We can readily check the condition under the dressing since the material is see-through. Basically, the dressing does not need renewal for several days. This is advantageous in terms of cost-performance [1, 2]. In addition, Karayahesive No. 6 costs 40% of the smallest product of an Isodine drape (285 versus 719 Japanese Yen per sheet). An Isodine drape inadequately adhesive comes off sometimes and needs to be reupholstered; this makes the cost even higher.
It was an easy matter to remove the Karayahesive® used; just peeled off. Because moisture had been maintained at the skin edges, the tissues there remained in a good condition without necrosis or dried-up damage. Debridement of the wound margin was not necessary.
Some articles have been published reporting use of this material in cardiac surgery [3,4,5]. We focused on its use in delayed sternal closure. Our current experience enhances the opinions previously described. Being nicely air-tight, appropriately adhesive, easy to handle, and moisture controlling, this material appeared to assist wound healing and protect against bacterial infection. We would not hesitate to employ this material in a similar circumstance.