Closed-Incision Negative-Pressure Therapy Reduces Donor-Site Surgical Wound Dehiscence in DIEP Flap Breast Reconstructions: A Randomized Clinical Trial.

Abstract

BACKGROUND:

In breast reconstruction operations, surgical wound dehiscence is a serious complication that generates a significant burden on patients and health care systems. There are indications that postoperative treatment with closed-incision negative-pressure therapy has been associated with reduced wound dehiscence rates. This randomized clinical trial examines the effect of closed-incision negative-pressure application on abdominal donor-site surgical wound dehiscence in low- and high-risk patients undergoing breast reconstruction with a deep inferior epigastric perforator flap.

METHODS:

Eighty eligible women, stratified as low- or high-risk patients, were included and were randomized for treatment with either closed-incision negative-pressure or adhesive strips by drawing sealed, opaque envelopes. All surgeons were kept blinded for allocation. Primary outcomes were surgical wound dehiscence and surgical-site infection at the abdominal donor site on follow-up after 12 weeks. Secondary outcomes were seroma and hematoma formation. Five patients were excluded from the study because of insufficient exposure to the study treatment ( n = 4) or major protocol deviation ( n = 1).

RESULTS:

A total of 75 women, low-risk ( n = 38) and high-risk ( n = 37), received either closed-incision negative-pressure ( n = 36) or adhesive strips ( n = 39). Patients' demographics did not differ significantly. Donor-site surgical wound dehiscence occurred in 23 patients; the absolute risk reduction was statistically significant (21.6 percent; 95 percent CI, 1.5 to 41.7 percent). No statistically significant differences were found in surgical-site infection or secondary outcomes.

CONCLUSION:

In this randomized clinical trial, postoperative treatment with closed-incision negative-pressure therapy decreased the incidence of surgical wound dehiscence at the abdominal donor site in low- and high-risk deep inferior epigastric perforator flap breast reconstruction patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.

• Authors: Emmy Muller-Sloof, Erik de Laat, Onur Kenç, Ali Kumaş, Hester Vermeulen, Stefan Hummelink, Dietmar J O Ulrich
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 150 Pg. 38S-47S (10 01 2022) ISSN: 1529-4242 [Electronic] United States
• PMID: 35943913 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2022 by the American Society of Plastic Surgeons.

Topics

• Female
• Humans
• Mammaplasty (adverse effects, methods)
• Negative-Pressure Wound Therapy (methods)
• Perforator Flap (adverse effects)
• Postoperative Complications (epidemiology, etiology, prevention & control)
• Retrospective Studies
• Surgical Wound (complications)
• Surgical Wound Dehiscence (epidemiology, etiology, prevention & control)
• Surgical Wound Infection (epidemiology, etiology, prevention & control)