Closed Incision Negative Pressure Therapy in Oncological Breast Surgery

Comparison With Standard Care Dressings

Pietro M. Ferrando, MD, PhD; Ada Ala, MD; Riccardo Bussone, MD; Laura Bergamasco, PhD; Federica Actis Perinetti, MD; Fabrizio Malan, MD

Disclosures

Plast Reconstr Surg Glob Open. 2018;6(6):e1732 

In This Article

Abstract and Introduction

Abstract

Background: Negative pressure wound therapy was developed for treating wounds associated with unfavorable healing factors. The principles of the negative pressure wound therapy applied on clean and closed surgical incision originate the closed incision negative pressure therapy (ciNPT). We evaluated the use of ciNPT in the setting of oncological breast surgery.

Methods: From January 1, 2015, to June 31, 2015, we prospectively selected 37 patients undergoing oncological breast surgery with a minimum of 4 risk factors. Seventeen patients (25 surgeries) voluntary tested ciNPT (ciNPT sample), whereas the remaining 20 (22 surgeries) chose conventional postsurgery dressing (Standard Care sample). Follow-up controls to evaluate postsurgical complications were performed on days 7, 14, 30, and 90. At 12 months, the quality of life, scar, and overall aesthetic outcomes were evaluated with specific questionnaires filled in by surgeon and patient. The Standard Care sample was investigated on risk factors associated with poor healing.

Results: The ciNPT sample showed a significant prevalence of high risk factors, especially extensive undermining and bilateral surgeries, and a predominance of women under 65 years; only 1/25 (4%) surgical procedures was followed by complications. In the Standard Care sample, 10 of 22 surgeries (45%) were followed by complications. The difference in complication rate between the 2 samples was significant. The BIS (Body Image Scale) scores suggested that most patients were satisfied with their body image regardless of the type of dressing. All other questionnaire scores clearly vouched for a significant superiority of the ciNPT. Previous surgery ≤ 30 days emerged as the surgery-related high risk factor most frequently associated with postsurgery complications.

Conclusion: The results of our study support the use of ciNPT in oncological breast surgery: it showed to be a well-tolerated, adaptable, and reliable dressing capable of reducing postsurgical complications and improving scar outcomes in patients presenting with high risk factors.

Introduction

Oncologic breast surgery, employing techniques ranging from more conservative breast-conserving surgery (BCS) to intermediate oncoplastic surgery[1–3] (OPS) to more radical ones (mastectomies, with or without tissue sparing and reconstructions), is an expanding and increasingly demanding field of surgery. The literature reports overall complication rates up to 35% for BCS cases,[4,5] 50% for breast reconstruction,[6,7] and 30% for OPS.[8] Postsurgical complications affect the quality of life, increase the costs of the health system, and may delay the beginning of adjuvant therapies.[9]

Negative pressure wound therapy was developed for treating wounds associated with unfavorable healing factors.[10] It proved to be effective in the treatment of many chronic[11] and surgical wounds,[12] including breast surgery.[13] The principles of the negative pressure wound therapy applied on clean and closed surgical incision originate the closed incision negative pressure therapy (ciNPT). A 2016 international consensus conference stated that the use of ciNPT in surgical procedures on high-risk patients appears to have the potential for reducing surgical incision complications and health care costs.[14]

In our institution, ciNPT with Prevena (KCI, an Acelity company, Sant Antonio, Tex.) is currently being used on abdominal wall reconstruction incisions of high-risk patients and on pathological scar revisions of severely burned patients, with good results in terms of suture dehiscence rate and scar features.[15] Our hypothesis was that ciNPT with Prevena could give better results than the conventional dressing also in patients undergoing complex oncological breast surgeries and reconstructions. We thus performed a small-size study including the presurgery evaluation of patient- and surgery-related risk factors and the postsurgery estimation of wound complications and aesthetic outcomes. Our aim was to obtain an indication on 2 issues: (1) efficacy of ciNPT compared with Standard Care; (2) risk factors associated with a poor outcome in the Standard Care sample that could be considered strong advocates of the use of ciNPT.

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