The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta‐Analysis

Abstract

Background Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery. Methods This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis. Results Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19-069; P = 0.002], SSI (OR 0.45; 95% CI 0.24-0.86; P = 0.015), seroma (OR 0.28; 95% CI 0.13-0.59; P = 0.001), wound dehiscence (OR 0.49; 95% CI 0.32-0.72; P \ 0.001) and wound necrosis (OR 0.38; 95% CI 0.19-0.78; P = 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19-3.2; P = 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes. Conclusion Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.

Incisional Negative Pressure Wound Therapy in Orthopaedic Trauma: Indications & Outcomes

“…Several meta-analyses and numerous randomized controlled trials have demonstrated its efficacy in decreasing the incidence of surgical site infections, wound dehiscence, and other postoperative wound complications. [14][15][16][17][18][19][20][21] A 2019 meta-analysis analyzed a total of 6 studies including 2 randomized controlled trials (RCTs) and 4 cohort studies comparing a mix of iNPWT systems to conventional wound dressings for closed incisions in orthopaedic trauma surgery. 14 Statistically significantly lower incidence of deep SSIs (P = 0.002), superficial SSI (P = 0.03), and wound dehiscence (P = 0.02) was found in surgical incisions managed with iNPWT.…”

Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery

“…These results are consistent with prophylactic ciNPWT use in multiple other surgical specialties, with favourable results. 41,42 Four studies evaluated local antibiotics placed within the surgical wound just prior to closure. The primary analyses suggest that local antibiotics do not prevent overall SSI rates; however, sensitivity analysis suggested they may prevent superficial SSIs.…”

The patient’s pathway for breast cancer in the COVID‐19 era: An Italian single‐center experience

“…All the appointments previously scheduled have been revised, reallocating all postoperative uneventful late follow‐ups to telematic consultations. Furthermore, to minimize the number of early postoperative accesses to the outpatient clinic, we have extended the application of negative pressure wounding dressings (eg, PICO, Smith & Nephew, London, UK) in higher‐level oncoplastic procedures, for the prevention of wound complications and reduction in time of cicatrization 7‐9 . Before the pandemic, we were conducting a clinical study on the application of this wound dressing and their possible advantages in the management of wound cicatrization.…”