by Muller-Sloof,
Emmy; de Laat, Erik; Kenç, Onur; Kumaş, Ali; Vermeulen, Hester; Hummelink,
Stefan; Ulrich, Dietmar J. O.
Plastic and Reconstructive Surgery: October 2022
- Volume 150 - Issue - p 38S-47S
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.
