The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes

Abstract

Background:Studies report that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits, including protecting surgical incisions, for postsurgical closed incisions (eg, orthopedic, sternotomy, and colorectal). This retrospective analysis compared postoperative outcomes in patients who received ciNPT versus standard of care (SOC) for incision management after breast reconstruction postmastectomy.Methods:Patient demographics, chemotherapy exposure, surgical technique, ciNPT use, number of drains, time to drain removal, and 90-day postoperative complication rates were analyzed from records of 356 patients (ciNPT = 177, SOC = 179) with 665 closed breast incisions (ciNPT = 331, SOC = 334).Results:Overall complication rate was 8.5% (28/331) in ciNPT group compared with 15.9% (53/334) in SOC group (P = 0.0092). Compared with the SOC group, the ciNPT group had significantly lower infection rates [7/331 (2.1%) versus 15/334 (4.5%), respectively; P = 0.0225], dehiscence rates [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0178], necrosis rates [17/331 (5.1%) versus 31/334 (9.3%), respectively; P = 0.0070], and seroma rates [6/331 (1.8%) versus 19/334 (5.7%), respectively; P = 0.0106]. The ciNPT group required significantly fewer returns to operating room compared with the SOC group [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0496]. Time to complete drain removal per breast for ciNPT versus SOC groups was 9.9 versus 13.1 days (P < 0.0001), respectively.Conclusions:Patients who received ciNPT over closed incisions following postmastectomy breast reconstruction experienced a shorter time to drain removal and significantly lower rates of infection, dehiscence, necrosis, and seromas, compared with the SOC group. Randomized controlled studies are needed to corroborate the findings in our study.

Closed incision negative pressure therapy following abdominoplasty after breast reconstruction with deep inferior epigastric perforator flaps

“…After DIEP flap reconstruction, both the reconstructed breasts and the donor site require postoperative care and monitoring to facilitate uncomplicated incision healing and minimal scarring. Closed incision negative pressure therapy (ciNPT) is one method of incision management that has been used to promote closure and support positive outcomes . In this study, we aimed to identify any differences in outcomes between patients receiving postoperative abdominal incision care using ciNPT and standard occlusive dressings.…”

“…Closed incision negative pressure therapy (ciNPT) is one method of incision management that has been used to promote closure and support positive outcomes. [2][3][4][5][6] In this study, we aimed to identify any differences in outcomes between patients receiving postoperative abdominal incision care using ciNPT and standard occlusive dressings.…”

Closed Incision Negative Pressure Therapy: Review of the Literature

“…The literature search identified 12 RCTs, a majority of which reported reduced SSI rates, reduced readmission rates, and reduced reoperation rates. Six of the non-RCT, comparative studies identified also reported reduced rates of SSIs, readmissions, and reoperations [20][21][22][23][24][25]. However, these studies examined a wide range of patients, with a variety of comorbidities, undergoing different surgical procedures.…”

“…The successful application of ciNPT on clean, closed wounds has been reported in a broad spectrum of patients and operative interventions resulting in positive clinical results in a majority of the RCTs identified in the literature search ( Table 2) [11][12][13][14][15][16][17][18][19]. Similarly, rates of SSIs, surgical site complications, readmissions, and/or reoperations were reduced in patients receiving ciNPT compared to historical control populations [20][21][22][23][24][25].…”

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

“…In patients who undergo direct-to-implant (DTI) breast reconstruction, the risk of postoperative infection is increased by factors such as smoking, obesity, previous chemotherapy, and prolonged drain use ( > 3 weeks) [6]. Implant-associated infections can result in prolonged antibiotic use, additional surgical treatment, and implant removal [7]. Therefore, the application of an NPWT device as a preventive or treatment option for mastectomy flap necrosis has been examined [8].…”