Impact of closed-incision negative pressure therapy in donor-site complications in DIEP flap breast reconstruction: Analysis of 705 patients and 1125 flaps

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2025-04-15 DOI:10.1016/j.bjps.2025.04.010

Maria J. Escobar-Domingo , Valeria P. Bustos , Amir-Ala Mahmoud , Micaela J. Tobin , John B. Park , Daniela Lee , Benjamin Rahmani , Reinhard M. Knerr , Chamilka Merle , Joshua A. Bloom , Samuel J. Lin , Bernard T. Lee

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引用次数: 0

Abstract

Background

Closed-incision negative pressure therapy (ciNPT) has been shown to reduce complication rates in breast reconstruction (BR). This study aimed to evaluate postoperative outcomes in deep inferior epigastric perforator (DIEP) donor-site incisions managed with ciNPT compared to standard dressings.

Methods

We performed a retrospective study of patients ≥18 years who underwent DIEP flap BR from 2015 to 2023. Patients who underwent reconstruction with alternative flaps or converted to transverse rectus abdominus myocutaneous were excluded. Patients were categorized according to the use of ciNPT vs. standard dressings. The unpaired t- and Fisher’s Exact tests were used to assess the differences between the groups. Multivariable logistic regression models were used to evaluate postoperative complications.

Results

A total of 705 patients were included, with 68 (9.6%) managed with ciNPT. Patients treated with ciNPT had significantly higher mean body mass index (BMI) (34.0 vs. 28.5 kg/m²; p<0.001) compared to the control group. Higher rates of alcohol use (59.2% vs. 41.2%; p=0.006) and hormonal therapy use (41.3% vs. 17.9%; p<0.001) were found in the standard dressing group. Univariate analyses showed no significant differences in donor-site postoperative outcomes across the groups. However, multivariate logistic regression models demonstrated a reduced likelihood of surgical site infection (OR 0.187; 95% CI 0.045–0.768); p=0.020), and wound dehiscence (OR 0.338; 95% CI 0.155–0.738); p=0.006) among the ciNPT users. Particularly, in patients with BMI >30 kg/m², ciNPT use (OR 0.282; 95% CI 0.098–0.812; p=0.019) was found to be a significant protective factor against wound complications compared to the standard of care.

Conclusions

Our findings suggest that ciNPT may improve wound complication rates in DIEP flap donor sites, especially in patients with high BMI. Further research is necessary to elucidate the cost-effectiveness of ciNPT based on the patient risk profiles.

查看原文本刊更多论文

闭合切口负压治疗对DIEP皮瓣乳房再造术供区并发症的影响：705例患者及1125个皮瓣分析

背景：闭合切口负压治疗（ciNPT）已被证明可以降低乳房重建术（BR）的并发症发生率。本研究旨在评价与标准敷料相比，使用ciNPT处理腹下深层穿支（DIEP）供区切口的术后效果。方法回顾性研究2015年至2023年接受DIEP皮瓣BR的患者，年龄≥18岁。接受替代皮瓣重建或转化为腹直肌横肌的患者被排除在外。根据使用ciNPT和标准敷料对患者进行分类。使用非配对t检验和Fisher精确检验来评估组间的差异。采用多变量logistic回归模型评估术后并发症。结果共纳入705例患者，其中68例（9.6%）采用ciNPT治疗。接受ciNPT治疗的患者的平均体重指数（BMI）明显更高(34.0 vs. 28.5 kg/m2；P<0.001)与对照组相比。较高的酒精使用率(59.2%对41.2%；P =0.006)和激素治疗使用(41.3% vs. 17.9%；P<0.001)。单因素分析显示各组供区术后结果无显著差异。然而，多变量logistic回归模型显示手术部位感染的可能性降低(OR 0.187；95% ci 0.045-0.768)；p=0.020)，创面裂开(OR 0.338；95% ci 0.155-0.738)；p=0.006)。特别是在BMI为30 kg/m2的患者中，ciNPT的使用(OR 0.282；95% ci 0.098-0.812；P =0.019)与标准护理相比，是防止伤口并发症的重要保护因素。结论ciNPT可改善DIEP皮瓣供区，尤其是高BMI患者的伤口并发症发生率。需要进一步的研究来阐明基于患者风险概况的ciNPT的成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.