Postoperative Mechanomodulation Decreases T-Junction Dehiscence After Reduction Mammaplasty: Early Scar Analysis From a Randomized Controlled Trial

Abstract

Background Mechanical and tensile forces play an important role in postoperative wound healing. Mitigating soft tissue and cutaneous tension is a key consideration in aesthetic and reconstructive procedures, as it is an important contributor to complicated wound healing and poor scar cosmesis after surgery. Objectives The study objective was to assess the efficacy of the force modulating tissue bridge (FMTB) (“Brijjit”, Brijjit Medical Inc, Atlanta, GA) in reducing mechanical tension on postoperative wounds in patients, using the vertical incision of a Wise-pattern reduction mammaplasty as a clinical model. Methods The authors conducted a prospective, single-center, randomized, within-subject clinical trial to evaluate wound healing and nascent scar formation after 8 weeks of postoperative wound support with FMTB. Patients received standard of care (SOC) subcuticular closure on the vertical incision of one breast and experimental closure using FMTB on the contralateral incision after Wise-pattern reduction mammaplasty. Dimensions of the nascent scar were analyzed using three-dimensional wound analysis and rates of T-junction dehiscence evaluated using in-person clinical assessment at 2-, 4-, 6-, and 8-week follow-up visits. Results Thirty-four patients (n = 68 breasts) completed 8 weeks of postoperative FMTB application. There was a reduced rate of early T-junction wound dehiscence in FMTB breasts (n = 1) compared to SOC breasts (n = 11) (p < 0.01; NNT = 3 breasts). Mean vertical incision wound area during the intervention period was decreased in the FMTB breast (1.5 cm2) compared to the SOC breast (2.1 cm2) (difference, 0.57; 95% CI: 0.30 to 0.85; p < 0.01) and was significantly lower at 2- (p < 0.01), 4- (p < 0.01) and 8-week (p < 0.01) follow-up. Only the closure method was significantly associated with variations in Week 8 wound area (p < 0.01) after linear regression modeling. No serious adverse events occurred. Conclusions Force modulating tissue bridges decrease nascent scar dimensions and reduce the occurrence of wound dehiscence. This represents the first level I evidence of using continuous mechanomodulation to reduce postoperative wound complications after skin closure.