Summary
Introduction
Deep inferior epigastric perforator (DIEP) flaps are considered the gold standard
for autologous breast reconstruction but create large abdominal incisions that risk
donor-site morbidity during harvest. Closed incision negative pressure therapy (ciNPT)
is emerging as an effective alternative to standard postoperative dressings, but there
is a paucity of data in DIEP flap donor sites.
Methods
We conducted a retrospective case-control study investigating the use of ciNPT in
DIEP flap donor sites at a single institution between March 2017 and September 2021.
Patients who underwent microsurgical autologous breast reconstruction with DIEP flaps
were included. Patients were divided into those with donor incision sites managed
with ciNPT (n = 24) and those with conventional postoperative wound dressings (n = 20). We compared patient demographics, wound drainage volumes and postoperative
outcomes between the two groups. A cost-benefit analysis was employed to compare the
overall costs associated with each complication and differences in length of stay
between the two groups.
Results
There was no statistically significant difference in age, body mass index (BMI), comorbidity
burden or smoking status between the two groups. Both groups had similar lengths of
stay and wound drainage volumes with no readmissions or reoperations in either group.
There was a statistically significant reduction in donor-site complications (p = 0.018), surgical site infections (p = 0.014) and seroma formation (p = 0.016) in those with ciNPT. Upon cost-benefit analysis, the ciNPT group had a mean
reduction in cost-per-patient associated with postoperative complications of £420.77
(p = 0.031) and £446.47 (p = 0.049) when also accounting for postoperative length of stay
Conclusion
ciNPT appears to be an effective alternative incision management system with the potential
to improve complication rates and postoperative morbidity in DIEP flap donor sites.
Our analysis demonstrates improved cost-benefit outweighing the increase in costs
associated with ciNPT. We recommend a multicentre prospective trial with formal cost-utility
analysis to strengthen these findings.
Keywords
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Article info
Publication history
Published online: August 04, 2022
Accepted:
August 1,
2022
Received:
February 7,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
