Closed incision negative pressure therapy following abdominoplasty after breast reconstruction with deep inferior epigastric perforator flaps

Abstract

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P < .05). No surgical site complications were reported in the ciNPT group within the follow‐up period. In the control group, one patient developed wound edge fat necrosis requiring reoperation. In conclusion, we report that ciNPT is a useful incision management system for DIEP flap donor site incisions and it facilitated improved scar quality over standard dressings in this small pilot study. Further clinical studies are required to assess the full advantages provided by ciNPT.

The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction

“…The present study has some limitations. The number of patients was small, though still comparable to other similar studies in the literature [ 17 , 20 ]. This might lead to a type 2 statistical error, explaining the lack of statistical evidence for the effectiveness of CINPT in TMG flap breast reconstruction despite the observed differences between both study groups.…”

“…The advantages of CINPT have been outlined in multiple studies in plastic and reconstructive surgery as well as in oncological breast surgery [ 13 , 14 , 15 , 16 ]. In particular, evidence exists for the superiority of CINPT compared to conventional wound management at the donor site of patients undergoing free flap breast reconstruction from the lower abdomen [ 17 , 18 , 19 , 20 ]. This is the first study to evaluate the use of CINPT on donor site healing and patient perception in TMG flap breast reconstruction.…”

The use of closed incision negative pressure therapy for incision and surrounding soft tissue management: Expert panel consensus recommendations

“…For highly visible incisions, or those resulting from cosmetic procedures, scar appearance is also an important outcome. Improved scar appearance has been observed in incisions managed with ciNPT versus control dressings for abdominal flap donor sites, 70 abdominoplasty, 71 and breast surgery in high‐risk patients 52 . A recent systematic review identified a moderate level of evidence supporting the use of ciNPT to improve scarring characteristics 72 .…”

Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

“…Our study findings add to the body of literature on this topic. Several studies have shown promising results with ciNPT for general wound management [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Smolle et al demonstrated a reduction in wound complications in patients who received ciNPT for orthopaedic surgical sites (total joint arthroplasty) and colorectal laparotomy sites [ 14 ].…”

“…This is the largest study to our knowledge investigating the use of ciNPT for breast reconstruction abdominal donor sites. Fang et al retrospectively compared outcomes in 10 patients with abdominal free flap breast reconstructions (ciNPT = 5, non-ciNPT = 5), concluding that ciNPT dressings resulted in faster wound healing and better cosmesis; however, without statistical significance [ 16 ]. Muller-Sloof et al conducted a prospective randomised control trial of 51 patients (ciNPT = 25, non-ciNPT = 26) who underwent breast reconstruction with abdominal free flaps, comparing ciNPT (Prevena) with standard adhesive dressings, demonstrating a reduction in incidence of wound dehiscence in the ciNPT cohort [ 15 ].…”