The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction

Abstract

The objective of this study was to examine the impact of closed incision negative pressure therapy (CINPT) on donor site complications and patient perceptions in transverse musculocutaneous gracilis (TMG) flap breast reconstruction. Our institution conducted a retrospective cohort study, including all patients with TMG flap breast reconstruction from 1 January 2010 to 31 December 2021. Patients were grouped according to conventional wound management or CINPT. Outcomes were surgical site complications, fluid drainage, time to drain removal, and in-hospital stay length. A patient survey was created. A total of 56 patients with 83 TMG flaps were included (control group: 35 patients with 53 TMG flaps; CINPT group: 21 patients with 30 TMG flaps). Patient characteristics were similar in both groups. The flap width was significantly larger in the CINPT group (8.0 cm vs. 7.0 cm, p = 0.013). Surgical site complications were reduced in the CINPT group without statistical difference (30.0% vs. 50.9%, p = 0.064). Fluid drainage and time to drain removal were similar in both groups. The average in-hospital stay was significantly shortened in the CINPT group (10.0 days vs. 13.0 days, p = 0.030). The survey excluded pain, skin irritations, and discomfort during sleep and movement in the CINPT group and showed that the patients felt well protected. This study fails to provide compelling evidence for CINPT to enhance incision healing on the donor site in TMG flap breast reconstruction. There was a trend toward reduced surgical site complications on the donor thigh and the in-hospital stay was shortened. Prophylactic CINPT increases patient comfort and provides a feeling of additional wound protection.

Closed Incision Negative-Pressure Therapy on Free Flap Donor Sites: A Meta-analysis of Postoperative Outcomes

“…21 Drains were left in place in the donor site in most of our included studies, but only four studies reported the average time these drains remained in their patients. 10,12,13,18 All four of these studies reported no significant difference in time to drain removal when comparing their ciNPT group and conventional dressings group. In the studies that reported drain output as a measure, there was no difference between the two groups as well.…”

“…Selection bias is present in at least four of the included studies, as the authors acknowledge using ciNPT for wounds they deemed "high-risk," 14 or the authors switched their dressings after a certain time-point due to their clinical experiences. [16][17][18] Funnel plots were performed for each outcome analysis to test for publication bias. (See figure, Supplemental Digital Content 2, which displays funnel plots of standard error by log odds ratio assessing publication bias for the meta-analyses performed.…”

“…Seven of the included studies were retrospective cohort studies, two were retrospective case-control studies, two were case series, and one was a randomized control trial. Seven of the studies investigated abdominal donor sites; [8][9][10][11][12][13][14] two of these investigated anterolateral thigh donor sites, 15,16 two investigated medial thigh donor sites, 17,18 and one investigated posterior trunk donor sites. 19 In regard to the reconstructed area, the majority (nine studies) investigated free tissue transfer to the breast.…”

Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula

“…Negative pressure wound therapy (NPWT), which is well known in the surgical field, is a platform that promotes wound healing by applying localized negative pressure to the wound 10 . Functionally, NPWT can remove excess fluid from the wound and provide a moist environment for wound healing 11 .…”

“…Negative pressure wound therapy (NPWT), which is well known in the surgical field, is a platform that promotes wound healing by applying localized negative pressure to the wound. 10 Functionally, NPWT can remove excess fluid from the wound and provide a moist environment for wound healing. 11 In 1997, NPWT was introduced into clinical practice in its current form and used mainly in the treatment of chronic wounds, such as diabetic foot, and infected traumatic wounds.…”