The Northeastern Society of Plastic Surgeons

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Impact of Closed Incision Negative Pressure Therapy on Postoperative Outcomes in Breast Reconstruction
Allen Gabriel1, Steven Sigalove2, Ronald Silverman3, Leah Griffin4, Patrick Maxwell5.
1PeaceHealth Medical Group, Vancouver, WA, USA, 2DuPage Medical Group, Glen Ellyn, IL, USA, 3UMMC, Baltimore, MD, USA, 4Acelity, San Antonio, TX, USA, 5Loma Linda University Medical Center, Loma Linda, CA, USA.

BACKGROUND: Evidence suggests that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits in various surgical applications, such as orthopedic, sternotomy, abdominal wall repairs, and colorectal procedures, by protecting surgical incisions and removing fluid and infectious materials. This study compares postoperative outcomes, including complication rates and drain use, among patients using ciNPT versus standard of care (SOC) after breast reconstruction.
METHODS: This single-site, retrospective cohort study included data for breast reconstruction procedures from October 1, 2013 - March 31, 2016. Data collected included demographics, chemotherapy/radiation exposure, surgical technique, ciNPT use, number of drains, total drain duration, and 90 day postoperative complication rates. Two-sided T-test and Chi-square or Fisher's Exact tests were performed at α=0.05.
RESULTS: The study included data on 155 patients (ciNPT=64, SOC=91) and 294 breasts (ciNPT=125, SOC=169). There were no significant differences in mean age, body mass index, proportion of smokers, and patients with hypertension between the two groups. The ciNPT group had a lower proportion of patients that had prior breast surgery and radiation exposure. There were no significant differences in chemotherapy exposure before the 1st stage of reconstruction, but the ciNPT group had lower percentage of patients who had chemotherapy exposure after the 1st stage of reconstruction. More patients in the ciNPT group underwent a pre-pectoral technique of breast reconstruction compared to the SOC group. Complication rates were examined at the breast level (Table 1). The overall complication rate was 7 (5.6%) in the ciNPT group compared to 24 (14.2%) in the SOC group (p=0.0176). Significant differences were found in the infection rates [0 (0%) vs 10 (5.9%); p=0.0059], rates of dehiscence [0 (0%) vs 11 (6.5%);p=0.0030], rates of necrosis [1 (0.8%) vs 16 (9.5%); p=0.0016] and returns to the OR [0 (0%) vs 11 (6.5%); p=0.0003] when comparing the ciNPT and SOC groups, respectively. There were no significant differences in number of seromas and hematomas between the two groups. All patients in the ciNPT group (100%) had 2 drains compared to 81.7% of the SOC group (p<0.0001). The ciNPT group had significantly lower mean drain days per-drain (6.1 vs. 9, p<0.0001) and total drain days (12.2 vs. 18.1, p<0.0001) compared to the SOC group.
CONCLUSIONS: Our study demonstrated significantly lower complication rates and drain duration among the ciNPT group. These results may translate to improved patient outcomes and efficient use of resources in a hospital setting. Further randomized controlled studies are needed to corroborate the findings in our study.

Complication rates between ciNPT and SOC groups (breast-level)
SOC N=169 n (%)ciNPT N=125 n (%)p-value
Any Complication24 (14.2%)7 (5.6%)0.0176
Surgical site infection10 (5.9%)0 (0%)0.0059
Dehiscence11 (6.5%)0 (0%)0.0030
Necrosis16 (9.5%)1 (0.8%)0.0016
Seroma7 (4.1%)1 (0.8%)0.1442
Hematoma4 (2.4%)5 (4.0%)0.5024
Return to operating room11 (6.5%)0 (0%)0.0003

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