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

Abstract

We performed a meta-analysis to evaluate the effect of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery. A systematic literature search up to April 2022 was performed and 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. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery using the dichotomous method with a random or fixed-effect model. The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problems (OR, 0.62; 95% CI, 0.43-0.90, P = .01), lower surgical site wound infection (OR, 0.59; 95% CI, 0.36-0.96, P = .03), lower wound dehiscence (OR, 0.54; 95% CI, 0.39-0.75, P < .001) and lower wound necrosis (OR, 0.44; 95% CI, 0.27-0.71, P < .001), 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 (OR, 0.73; 95% CI, 0.32-1.65, P = .45), and hematoma (OR, 0.73; 95% CI, 0.33-1.59, P = .001) compared with standard dressings in women with closed incisions in breast cancer surgery. The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problems, surgical site wound infection, wound dehiscence, and wound necrosis and no significant difference in wound seroma, and hematoma compared with standard dressings in women with closed incisions in breast cancer surgery. The analysis of outcomes should be with caution because of the low sample size of 5 out of 12 studies in the meta-analysis and a low number of studies in certain comparisons.

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

“…Wound dehiscence has been shown to cause significant morbidity, including decreased patient quality of life, prolonged hospital stays, and increased care costs. 17,27,[31][32][33][34][35][36][37][38][39][40][41][42] Our finding is congruent with other studies examining ciNPWT in orthopedic trauma, 5,43 breast surgery, 11,14,15,44 abdominal wall reconstruction, 34,45 laparotomy, 46,47 ventral hernia repair, 48 and reviews combing multiple types of procedures. 36,41,45,[49][50][51][52] However, results in the literature are mixed, and other studies do not show this relationship.…”

“…This contradicts several studies demonstrating decreased surgical site infection rates with ciNPWT. [5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing.…”

“…Some studies demonstrate a benefit on rates of seroma with the use of ciN-PWT, 11,41,44,49,50,52,54,55,63 but results are mixed. [6][7][8][13][14][15]33,45,48,61 Seromas develop as a result of the accumulation of serum in internal spaces. In vivo studies have shown improved fluid flow within 4 days of ciNPWT, resulting in decreased porcine subcutaneous dead spaces and therefore reduced risk of seroma.…”

“…Recent meta-analyses have shown that prophylactic ciNPWT reduced overall complication rates in breast reconstruction. 11 , 12 , 14 , 30 Here, we present the first meta-analysis to investigate the efficacy of ciNPWT in MR using abdominal donor sites.…”

“…A systematic review and meta-analysis recently demonstrated reduced overall wound complications and flap necrosis using ciN-PWT in implant-based breast reconstruction, and several reviews have shown benefit in primary wound closure. [10][11][12][13][14][15] However, the utility of ciNPWT on donor site morbidity in MR has not been systematically reviewed to date. The purpose of this study was to assess the efficacy of prophylactic ciNPWT over standard dressings on abdominal donor site complications in MR.…”