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

Abstract

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post-surgery in the ciNPT group compared with control (P < .05). No surgical site complications were reported in the ciNPT group within the follow-up period. In the control group, one patient developed wound edge fat necrosis requiring reoperation. In conclusion, we report that ciNPT is a useful incision management system for DIEP flap donor site incisions and it facilitated improved scar quality over standard dressings in this small pilot study. Further clinical studies are required to assess the full advantages provided by ciNPT.

Keywords: breast reconstruction; cicatrix; negative pressure wound therapy; surgical wound; wound healing.

Figure 1

Application of closed incision negative pressure therapy (A) or occlusions dressings (B) on postoperative day 1

Figure 2

Scores of scarring in patients receiving incision care with ciNPT or control at 3‐, 6‐, and 12‐month follow‐ups. Higher scores represent more prominent scarring characteristics. Each symbol represents one patient. All differences were significant (P < .05) except for height at 12‐month follow‐up (grey box; P = .067). ciNPT, closed incision negative pressure therapy

Figure 3

Comparison of incision appearance at 12 months after surgery in the negative pressure therapy (A–E) and control groups (F–J)