Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality

Abstract

BackgroundNegative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast.MethodsThe primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity.ResultsFor the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used.ConclusionsOur study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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

“…18 Tanaydin et al also reported that ciNPT over inframammary incisions resulted in a significant improvement over fixation strips in scar quality and appearance, assessed using the Patient Scale and Observer Scale and the Visual Analogue Scale at 42, 90, and 180 days. 19 In contrast, Svensson-Björk et al noted no significant differences between ciNPT and standard dressings for inguinal vascular surgical scars evaluated using the Patient Scar Assessment Scale, the Stony Brook Scar Evaluation, a 10-point-graded numeric ranking scale, and a modified Vancouver Scar Scale. 20 However, in this study population, the majority of surgical scars in both groups received the best possible scores indicating minimal baseline scarring, leaving little room for comparative differences.…”

“…Likewise, Ferrando et al discovered that using ciNPT over oncological breast surgical incisions was significantly associated with better scores compared with standard dressings on three different scar assessment scales: the two physician‐evaluated Observer Scar Assessment Scale and Manchester Scar Scale; and the patient‐evaluated Patient Scar Assessment Scale . Tanaydin et al also reported that ciNPT over inframammary incisions resulted in a significant improvement over fixation strips in scar quality and appearance, assessed using the Patient Scale and Observer Scale and the Visual Analogue Scale at 42, 90, and 180 days . In contrast, Svensson‐Björk et al noted no significant differences between ciNPT and standard dressings for inguinal vascular surgical scars evaluated using the Patient Scar Assessment Scale, the Stony Brook Scar Evaluation, a 10‐point‐graded numeric ranking scale, and a modified Vancouver Scar Scale .…”

A systematic review evaluating the influence of incisional Negative Pressure Wound Therapy on scarring

“…16 The animal studies evaluated these outcome on either postoperative day (POD) 3, 4, 5, 7, 8, 21, or 40. [16][17][18][19] Nine clinical articles reported clinical patient and observerreported outcomes, among which five RCTs, [21][22][23][24][25] three prospective comparative studies, [26][27][28] and one retrospective comparative study. 29 Clinical studies reported results after abdominoplasty, 29 circumferential thigh lift, 26 oncological breast surgery, 27 breast tissue expansion, 21 laparotomy, 25,28 vascular groin surgery, 22 reduction mammoplasty, 23 and coronary artery bypass grafting.…”

“…[16][17][18][19] Nine clinical articles reported clinical patient and observerreported outcomes, among which five RCTs, [21][22][23][24][25] three prospective comparative studies, [26][27][28] and one retrospective comparative study. 29 Clinical studies reported results after abdominoplasty, 29 circumferential thigh lift, 26 oncological breast surgery, 27 breast tissue expansion, 21 laparotomy, 25,28 vascular groin surgery, 22 reduction mammoplasty, 23 and coronary artery bypass grafting. 24 Scar scales used by the clinical studies involved the Vancouver Scar Scale (VSS), 22,29 Stony Brook Scar Evaluation Scale (SBSES), 22,26 Observer Scar Assessment Scale (OSAS), 27 Patient Scar Assessment Scale (PSAS), 22,27 Manchester Scar Scale (MSS), 27 Body Image Scale (BIS), 27 Visual Analog Scale (VAS), [21][22][23]28 Patient and Observer Scar Assessment Scale (POSAS).…”

Application of Negative Pressure Wound Therapy on Closed Incisions

“…The use of incisional NPWT is thus highly recommended in elderly patients, who have significant increased risk of developing SSE when compared with younger patients [61]. Other studies have concluded that incisional NPWT applied to closed surgical incisions on healthy patients after breast reduction surgery prevented postsurgical wound complications significantly [62].…”