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Does Preventive Negative Pressure Wound Therapy (NPWT) reduce local complications following Lymph Node Dissection (LND) in the management of metastatic skin tumors?

Published:August 23, 2022DOI:https://doi.org/10.1016/j.bjps.2022.08.054

      Summary

      Introduction

      Axillary and inguinal lymph node dissection (LND) are performed in metastatic skin tumors with several local complications, such as lymphorrhea, lymphoceles, and lymphedema. The purpose of this study is to determine whether negative pressure wound therapy (NPWT) applied as a preventive measure could improve outcomes.

      Materials and Methods

      A monocentric study included patients who underwent axillary or inguinal LND from May 2010 to March 2020, with a retrospective evaluation of prospectively collected data. Patients were divided into two groups: the conventional wound care (CWC) and the NPWT groups. Patients were systematically reviewed at D7, D30, and at 1 year postoperative, and data regarding lymphorrhea, lymphoceles, and lymphedema were collected.

      Results

      A total of 109 axillary and inguinal LND were performed. NPWT was applied on 68 LND and CWC on 41 LND. The variables, diabetes, smoking, gender, associated treatments, and primary pathology (melanoma, squamous cell carcinoma, or Merkel tumors) were similar in both groups.
      Analyses have shown a significant difference in the rate of scar disunion during the first month between the two groups (p=0.045 between D1 and D7; p=0.011 between D8 and D30), as well as the presence of lymphorrhea (p=0.000 between D1 and D7; p=0.002 between D8 and D30). The rate of lymphoedema was significantly reduced in the NPWT group versus CWC (p=0.000 between D8 and D30; p=0.034 between D31 and 1 year).

      Conclusion

      NPWT reduces local complications (scar disunion, lymphorrhea, and lymphedema) during the first year following LND in the management of node metastatic skin tumors.

      Keywords

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      References

        • Olds CE
        • Pepper J-P.
        Health outcome studies in skin cancer surgery.
        Facial Plast Surg Clin North Am. feb 2019; 27: 163-170
        • Delgado AF
        • Delgado AF.
        Complete lymph node dissection in melanoma: A systematic review and meta-analysis.
        Anticancer Res. Dec 2017; 37: 68259
        • de Vries M
        • Hoekstra HJ
        • Hoekstra-Weebers JEHM.
        Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma.
        Ann Surg Oncol. Oct 2009; 16: 28407
      1. Moffatt C, Banwell P, Vowden P, Franks P, Gottrup F, Horch RE, et al. Senior editorial advisor:19.

        • Sjögren J
        • Gustafsson R
        • Nilsson J
        • Malmsjö M
        • Ingemansson R.
        Clinical outcome after poststernotomy mediastinitis: Vacuum-assisted closure versus conventional treatment.
        Ann Thorac Surg. June 2005; 79: 2049-2055
        • Stannard JP
        • Volgas DA
        • Stewart R
        • McGwin G
        • Alonso JE.
        Negative pressure wound therapy after severe open fractures: A prospective randomized study.
        J Orthop Trauma. 2009; 23: 6
        • Blume PA
        • Walters J
        • Payne W
        • Ayala J
        • Lantis J.
        Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers.
        Diabetes Care. 2008; 31: 6
        • Jørgensen MG
        • Toyserkani NM
        • Thomsen JB
        • Sørensen JA.
        Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control series.
        J Plast, Reconstruct Aesthet Surg. 2019; 72 (jul): 1178-1183
        • Tauber R
        • Schmid S
        • Horn T
        • Thalgott M
        • Heck M
        • Haller B
        • et al.
        Inguinal lymph node dissection: Epidermal vacuum therapy for prevention of wound complications.
        J Plast, Reconstruct Aesthet Surg. 2013; 66 (march): 390-396
        • Denzinger S
        • Lübke L
        • Roessler W
        • Wieland WF
        • Kessler S
        • Burger M.
        Vacuum-assisted closure versus conventional wound care in the treatment of wound failures following inguinal lymphadenectomy for penile cancer: A retrospective study.
        Eur Urol. May 2007; 51: 1320-1325
        • Ravisankar P
        • Malik K
        • Raja A
        • Narayanaswamy K.
        Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: Results from a randomized clinical trial.
        Scand J Urol. Sep 2021; : 1-6
        • Hyldig N
        • Birke-Sorensen H
        • Kruse M
        • Vinter C
        • Joergensen JS
        • Sorensen JA
        • et al.
        Meta-analysis of negative-pressure wound therapy for closed surgical incisions.
        BJS. 2016; 103: 47786
        • Berner-Hansen V
        • Oma E
        • Willaume M
        • Jensen KK
        Prophylactic negative pressure wound therapy after open ventral hernia repair: A systematic review and meta-analysis.
        Hernia. 2021; 25 (déc)148190
        • Guo C
        • Cheng T
        • Li J.
        Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: A systematic review and meta-analysis.
        Int J Gynaecol Obstet. 2021; (3 déc)
        • Acosta S
        • Björck M
        • Wanhainen A.
        Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery.
        BJS. 2017; 104: e7584
        • Maranna H
        • Lal P
        • Mishra A
        • Bains L
        • Sawant G
        • Bhatia R
        • et al.
        Negative pressure wound therapy in grade 1 and 2 diabetic foot ulcers: A randomized controlled study.
        Diabetes Metab Syndr. 2021; 15 (févr): 36571
        • Liu S
        • He CZ
        • Cai YT
        • Xing QP
        • Guo YZ
        • Chen ZL
        • et al.
        Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: Systematic review and meta-analysis.
        Ther Clin Risk Manag. 2017; 13: 53344
        • Costa ML
        • Achten J
        • Knight R
        • Png ME
        • Bruce J
        • Dutton S
        • et al.
        Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT.
        Health Technol Assess. 2020; 24 (août): 186
        • Norman G
        • Goh EL
        • Dumville JC
        • Shi C
        • Liu Z
        • Chiverton L
        • et al.
        Negative pressure wound therapy for surgical wounds healing by primary closure.
        Cochrane Database Syst Rev. 2020; 5 (1 mai)CD009261
        • Matatov T
        • Reddy KN
        • Doucet LD
        • Zhao CX
        • Zhang WW.
        Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients.
        J Vasc Surg. 2013; 57 (1 mars): 7915
        • Bedi M
        • King DM
        • DeVries J
        • Hackbarth DA
        • Neilson JC.
        Does vacuum-assisted closure reduce the risk of wound complications in patients with lower extremity sarcomas treated with preoperative radiation?.
        Clin Orthop Relat Res. 2019; 477 (avr): 76874
        • Denzinger S
        • Lübke L
        • Roessler W
        • Wieland WF
        • Kessler S
        • Burger M.
        Vacuum-assisted closure versus conventional wound care in the treatment of wound failures following inguinal lymphadenectomy for penile cancer: A retrospective study.
        Eur Urol. 2007; 51 (mai): 13205
        • Cai T
        • Zhang L
        • Zhu K
        • Hu J
        • Zhan T
        • Liu L
        • et al.
        Retrospective clinical evaluation of negative-pressure wound therapy for infection prevention following malignant pelvic bone tumor resection reconstruction.
        Adv Skin Wound Care. 2021; 34 (janv): 16
        • Wang Y
        • Yao X
        • Lin Y
        • Wang J
        • Chang C.
        Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta-analysis.
        International Wound Journal. 2022; 19 (mars): 57382