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

Abstract

As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become available. To expand upon previous ciNPT recommendations and provide guidance on this new dressing, an expert panel of plastic surgeons convened to review the current literature, identify challenges to the implementation and sustainability of ciNPT, and use a modified Delphi technique to form a consensus on the appropriate use of ciNPT with full‐coverage dressings. After three rounds of collecting expert opinion via the Delphi method, consensus was reached if 80% of the panel agreed upon a statement. This manuscript establishes 10 consensus statements regarding when ciNPT with full‐coverage foam dressings should be considered or recommended in the presence of patient or incision risk factors, effective therapeutic settings and duration, precautions for use, and tools and techniques to support application. The panel also discussed areas of interest for future study of ciNPT with full‐coverage dressings. High‐quality, controlled studies are needed to expand the understanding of the benefits of ciNPT over the incision and surrounding tissues.

Closed Incision Negative Pressure Therapy in Oncoplastic Breast Surgery: A Comparison of Outcomes

“… 18 Furthermore, Silverman et al described expert panel consensus guidelines detailing indications for closed incision negative pressure dressing for soft tissue management that also included immunosuppression and previous surgery as additional reasons to consider ciNPT. 19 Therefore, surgeons at our institution typically opt for ciNPT in high-risk patients with these characteristics. Given this, it is not surprising that the ciNPT cohort had higher BMI and ASA levels in our study.…”

“…More recently, the surgeons in this study adhere to the expert consensus ciNPT guidelines for incision and soft tissue management. 19 , 20 Third, we did not collect the dates of when complications occurred, and therefore, there is survivorship bias as those with shorter follow-up times may seem to have fewer complications. However, as this was true for both cohorts, it is unlikely to have significant effects on our overall conclusions.…”

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

“…12 Increasing evidence for the benefits of CINPT in the field of vascular surgery, in particular, has emerged through recent meta-analyses and consensus recommendations. [13][14][15][16][17] The Prevena TM system (KCI Medical, San Antonio, TX) is a CINPT device which can be applied to closed incisions with continuous 125mmHg of negative pressure for up to seven days. This microdeformational system applies a highly porous material under suction to the wound surface, creating an environment for increased granulation tissue formation and decreased lateral tension.…”

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

“…Previous studies have confirmed its successful use on other donor sites in free flap microsurgery [ 16 , 18 ]. Additionally, new designs of negative pressure therapy, such as closed incision negative pressure therapy for incisions and surrounding soft tissue, rely on the safe application and off-label use of conventional products for negative pressure therapy for open wounds [ 32 ].…”