Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction

Abstract

Background: Single-use negative pressure wound therapy (NPWT) has been shown to encourage wound healing. It is often used when patient factors impair wound healing, or in more complex wounds, such as in implant-based breast reconstruction. We report the findings of a prospective cohort study comparing the use of NPWT with standard dressings in prepectoral breast reconstruction. Methods: A prospective database of implant-based reconstruction from a single institution was mined to identify patients who underwent prepectoral reconstruction. Patient demographics, operative data, surgical complications, and 90-day outcomes were compared between patients who had NPWT and those who had standard dressings. Results: Prepectoral implant-based breast reconstruction was performed on 307 breasts. NPWT dressings were used in 126 cases, with standard dressings used in 181 cases. Wound breakdown occurred in 10 cases after standard dressings versus 1 where NPWT was utilized. Of the standard dressing cases, only 3 implants were salvaged, while 7 cases led to implant loss. The 1 case of wound breakdown in the NPWT cohort settled with conservative measures. The cost of a reconstructive failure was £14,902, and the use of NPWT resulted in a cost savings of £426 per patient. Conclusions: The utilization of single-use NPWT reduces the rate of wound breakdown and implant loss in prepectoral implant-based reconstruction. In addition to the significant clinical benefits, this approach is cost-saving compared with standard dressings. These data suggest that prepectoral implant reconstruction should be considered as an indication for the use of NPWT.

Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction

“…Therefore, further surgical technical consideration is required to increase utilization of 1-stage direct-to-implant (DTI) reconstruction while minimizing complications. Advances such as adoption of DTI ADM pre- or sub-pectoral techniques 24 and the use of negative pressing wound therapy 25 may in future aid to reduce expander usage.…”

Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

“…One of the potential solutions that could help to achieve these goals may be the extensive and early use of Negative Pressure Wound Therapy (NPWT) devices in the prevention of wound healing complications 3 (mainly surgical site infections -SSI 4 or wound dehiscence), particularly among higher-risk patients, 5 those with complex incisions with ort without prosthetic devices underlying the closed incision. [6][7][8] Li et al proved that patients undergoing NPWT after open abdominal surgery had SSI less frequently 9 and the formation of enteroatmospheric fistulae were also less frequent in patients receiving. 10 The relative liberal use of ciNPWT, may well be advantageous for patients who are discharged as an inpatient earlier than normal to free up capacity for acute COVID beds may continue to receive good quality healthcare at home.…”

“…18 Similar benefits have been shown in the closed incision groups also. 7,19 The same principles will apply to acute and surgical wounds during the COVID-19 pandemic. This is especially important as there is evidence that the effectiveness of sNPWT is similar in inpatient and outpatient setting.…”

Comment on: “Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction”

“…We have read the article entitled “Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction” by Irwin et al 1 published in Plastic Reconstructive Surgery Global Open . The authors found a significant benefit using a 1-time negative pressure wound therapy (NPWT) dressing (PICO) compared with standard dressing; however, we believe there are critical methodological flaws that bias the presentation of the results.…”