Is negative-pressure wound therapy beneficial in modern-day breast surgery?

Abstract

Negative-pressure wound therapy (NPWT) is used to treat many different types of wounds, but there is still a lack of large studies describing its effectiveness in breast surgery. Enhanced recovery, reduction of complications, and good scar quality might be improved by the application of NPWT. Existing data show that vacuumassisted closure (VAC) application after expander-based breast reconstruction may be beneficial because of decreasing overall complications in comparison with standard wound treatment. There are few cases in which the use of negative pressure resulted in healing of complicated breast wounds after implant insertion-most breasts achieved healing, wherein duration of NPWT ranged from seven to 21 days. The use of NPWT leads to a decrease of seroma formation (from 70% to 15%), the mean percutaneous aspirated volume (from 193 ml to 26 ml) and the numbers of percutaneous aspirations (from three to one) in latissimus dorsi flap reconstruction. Furthermore, a prospective, within-patient, randomised study with 200 participants showed that treating closed incisional wounds after reduction mammoplasty with a VAC system resulted in a decrease of overall complications and protected against wound dehiscence. In the literature, there are cases showing that NPWT may be useful for the successful treatment of chronic and non-healing wounds, included non-puerperal mastitis and surgical sites affected by radiation therapy due to breast cancer. There is still a need for evidence confirming the effectiveness of NPWT in breast surgery because of the deficiency of large prospective studies that compare NPWT with standard treatment.

Successful use of minimal invasive debridement plus negative pressure wound therapy under skin flap and axillary region for refractory postmastectomy seroma: A STROBE-compliant retrospective study

“…UTH et al presents a 74-year-old man with a malignant melanoma suffering from seroma in the axilla after an axillary lymph node dissection and treated with vacuum-assisted closure to the seroma cavity and the researchers also note “it could be interesting to perform a prospective study concerning the use of V.A.C in seromas.” [ 20 ] Generating negative pressure is related with excess fluid removal, reduction of edema, increased dermal perfusion, stimulation of granulation tissue formation and reduced bacterial colonization. [ 21 , 22 ] There was no need to use prophylactic antibiotics in our patients with closed dressing technique that had a negative pressure effect.…”

Emerging treatment strategies in wound care

“… 129 This method also reduces edema, stimulates angiogenesis, helps to maintain wound moisture, and finally promotes contraction of the wound edges. This technique has been used for the treatment of acute and chronic wounds, open wounds, burns, diabetic wounds and also venous and arterial wounds 130 …”

“…This technique has been used for the treatment of acute and chronic wounds, open wounds, burns, diabetic wounds and also venous and arterial wounds. 130 …”

“…This technique has been used for the treatment of acute and chronic wounds, open wounds, burns, diabetic wounds and also venous and arterial wounds. 130 Overall, although many patients have been treated with NPWT, this include our own institute (Royal Free Hospital, London), but there is no concrete evidence that NPWT is significantly better than conventional therapy. There were some clinical trials, but not conclusive, hence a multicentre well organised clinical trial needs to verify the effectiveness of the NPWT as instrument for wound healing.…”

Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

“…In these cases, wound gaping would be a disastrous complication. Closed incisional negative pressure wound therapy (ciNPWT) has been well described for groin wounds following vascular surgeries, 3 knee and hip arthroplasties, 4 abdominoplasty incisions, 5 breast surgeries, 6 and abdominal wall reconstruction, 7 morbidly obese woman following cesarean section. 8 To the best of our knowledge application of ciNPWT at flap suture line following soft tissue reconstructive surgery has not been described previously.…”