Efficacy of Closed Incision Negative Pressure Wound Therapy on Abdominal Donor Site After Free Flap Breast Reconstruction

Andres F. Doval, MD; Vishwanath Chegireddy, MD; Lauren Beal, BA; Christian Arroyo-Alonso, MD; Dmitry Zavlin, MD; Aldona J. Spiegel, MD; Warren A. Ellsworth, MD

Disclosures

Wounds. 2021;33(4):81-85. 

In This Article

Abstract and Introduction

Abstract

Introduction: Negative pressure wound therapy (NPWT) has been used to treat acute and chronic wounds in a variety of scenarios. Specifically, in autologous breast reconstruction, studies investigating the use of closed incision NPWT (ciNPWT) in breast surgery are lacking.

Objective: The aim of this study was to analyze the use of ciNPWT at the abdominal donor site following deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Materials and Methods: A retrospective cohort study was conducted over a 15-month period including patients who underwent abdominally based microsurgical breast reconstruction. Patients were divided into 2 groups: (1) a control group that underwent standard abdominal donor site closure and (2) an experimental group that underwent standard abdominal donor site closure plus ciNPWT. Groups were compared in terms of demographic characteristics, perioperative variables, and abdominal donor site complications.

Results: A total of 42 patients were identified. Of these, 18 were included in the control group and 24 in the ciNPWT group. No cases of seroma, abdominal bulge, or abdominal hernia were reported. Wound dehiscence developed in 2 patients (11.1%) in the control group and in 3 patients (12.5%) in the experimental group (P = 1.000). One patient (5.6%) in the control group had an infection of the donor site compared with none in the ciNPWT group (P = .429). Interestingly, 3 patients developed hyperpigmentation where the ciNPWT plastic drape was placed.

Conclusions: The use of ciNPWT on the abdominal donor site following DIEP flap breast reconstruction did not lower the incidence of wound dehiscence and wound infection. Different approaches are needed to decrease the incidence of donor site complications in abdominally based postmastectomy breast reconstruction.

Introduction

The application of subatmospheric pressure to assist wound closure emerged as negative pressure wound therapy (NPWT) in early 1993.[1,2] This modality of care was initially used to rapidly achieve closure in wounds with difficult healing prognoses. Since its adoption, NPWT has been used to treat acute and chronic wounds in a variety of scenarios, such as exposed bone and tendons, exposed hardware, open abdominal wounds, skin grafts, and burns.[3,4]

The documented success of NPWT in open wound management sparked its use over closed, clean surgical incisions.[5,6] The proposed mechanism of action in closed incision NPWT (ciNPWT) involves improving wound perfusion by augmenting blood flow to the incision site, increasing granulation tissue, decreasing bacterial load, and minimizing edema formation, thus accelerating the wound healing process.[2,7,8]

Recently, ciNPWT has been employed following autologous breast reconstruction utilizing the deep inferior epigastric perforator (DIEP) flap.[9] The DIEP flap has evolved as the preferred flap for breast reconstruction due to high success rates and overall patient satisfaction. However, it is not exempt from complications. Most common donor site complications after DIEP flap include seroma (4.5%–8.7%), wound dehiscence (9.0%–20.6%), hematoma (1.8%), infection (2.8%–7.2%), umbilical stalk necrosis (3.2%), abdominal bulge (0.1%–0.9%), and abdominal hernia (0.0%–0.9%).[10–13]

The application of NPWT in open wound management has been extensively described in the literature.[2,14,15] However, this therapy used with closed incisions has been less robustly analyzed. Studies investigating the use of ciNPWT in breast surgery are similarly lacking, and current literature focuses primarily on ciNPWT placement in the reconstructed breast.[9,16] Although a 2018 study concluded that ciNPWT used in patients undergoing autologous breast reconstruction decreased wound dehiscence at the donor site, to the authors' knowledge, this provided the only piece of published literature investigating the use of ciNPWT at the abdominal donor site.[17]

As previously highlighted, investigating the role of ciNPWT in reducing abdominal complications following DIEP flap proves necessary.[18] Therefore, the aim of this study was to analyze the effectiveness of ciNPWT at the abdominal donor site in preventing complications following DIEP flap breast reconstruction.

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