Closed Incisional Negative Pressure Therapy Significantly Reduces Early Wound Dehiscence after Reduction Mammaplasty

Abstract

Background: Closed incisional negative pressure therapy (ciNPT) has been shown to improve surgical outcomes. Functional reduction mammaplasty has a wound dehiscence rate of 25% and higher in most series, requiring extra care and delayed secondary healing. We aimed to determine if shifting from standard care dressings to ciNPT reduced early dehiscence after breast reduction. Methods: This multisurgeon retrospective study compared consecutive patients undergoing primary breast reduction dressed with ciNPT to similar patients with standard dressing materials. Perioperative management was otherwise unchanged. Early dehiscence was defined as incisional disruption requiring wound care within the first 30 postoperative days. Statistical analyses were performed using t-test and Fisher exact test. Results: We analyzed 79 patients with 158 breasts (114 standard and 44 ciNPT). Both groups were similar. Mean ages were 35 and 34 years; body mass index, 28.5 and 27.4 kg/m 2 ; and reduction volumes, 565 and 610 g, respectively. None were active smokers, and 9.5% were former smokers. Wise pattern skin incisions were used in all, and parenchymal resections mostly utilized superomedial pedicles. Median ciNPT treatment was 6 days. Early dehiscence was significantly lower with ciNPT, occurring in only 1 of 44 (2%) breasts, compared to 16 of 114 in the standard group (14%), P = 0.003, a relative risk reduction of 84%. Two control patients required debridement, whereas none of the ciNPT patients did. Conclusion: Application of ciNPT markedly decreased early dehiscence requiring wound care, compared to using standard dressings, in otherwise similarly risk-stratified breast reduction patients.

Effectiveness of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery: A meta‐analysis

“…A total of 1765 relevant studies were screened, of which 12 studies between 2014 and 2022, met the inclusion criteria, and were involved in the meta‐analysis. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Data obtained from these studies were shown in Table 2 .…”

“…The current meta‐analysis involved 2223 women with closed incisions in breast cancer surgery at the baseline of the studies; 964 of them were using the prophylactic application of negative pressure wound therapy, and 1259 were using standard dressings 18‐29 . With The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problem, lower surgical site wound infection, lower wound dehiscence, and lower wound necrosis, in women with closed incisions in breast cancer surgery compared with standard dressings.…”

“…The current meta-analysis involved 2223 women with closed incisions in breast cancer surgery at the baseline of the studies; 964 of them were using the prophylactic application of negative pressure wound therapy, and 1259 were using standard dressings. [18][19][20][21][22][23][24][25][26][27][28][29] With The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problem, lower surgical site wound infection, lower wound dehiscence, and lower wound necrosis, in women with closed incisions in breast cancer surgery compared with standard dressings. However, prophylactic application of negative pressure wound therapy did not show any significant difference in wound seroma, and hematoma compared with standard dressings in women with closed incisions in breast cancer surgery.…”

Factors related to necrosis at the T junction in reduction mammoplasty

“…The most common complication is wound healing disorders [5][6][7][8][9], which are considered minor complications in many studies [3][4][5][6][7][8][9][10][11][12]. However, the patient's need for postoperative dressing and prolonged care, as well as the increase in the number of postoperative visits reduce the costeffectiveness of the operation [14]. Studies report wound healing complication rates of up to 100%, and associate it with smoking, high body mass index [14], and increased resected volume [8].…”

“…Studies on obese patients showed that the quality of life increased after the operation despite minor complications, and breast reduction operations were cost-effective in the obese patient group as well [20]. The use of incisional vacuum therapy reduced delayed wound healing complications that may occur after breast reduction operations [12,14]. However, few studies are available and their effects on flap perfusion, which is the main cause of T junction problems, are not clear.…”