Efficacy of closed-incision negative pressure wound therapy in abdominal-based autologous breast reconstruction: A systematic review and meta-analysis

Introduction

Abdominal-based free tissue transfers, such as the Deep Inferior Epigastric Perforator (DIEP) flap, are widely utilized in autologous breast reconstruction. These procedures are often complicated by wound healing issues at the donor site, including wound dehiscence, seroma formation, and surgical site infections (SSIs). Closed Incision Negative Pressure Wound Therapy (ciNPWT) has been suggested to improve healing outcomes and reduce the incidence of postoperative complications. This synthesis evaluated the efficacy of ciNPWT compared to standard dressings in abdominal-based autologous breast reconstruction.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials and observational studies assessing ciNPWT versus standard dressings in patients undergoing abdominal-based free flap breast reconstruction were included. Primary and secondary outcomes analyzed were wound dehiscence, SSIs, seroma formation, and length of stay. Data from multiple databases were independently reviewed and synthesized using Review Manager 5.4 and Microsoft Excel. Studies were rigorously selected and assessed for risk of bias.

Results

Of the 348 identified articles, 13 studies met the inclusion criteria, comprising three randomized controlled trials and 10 observational studies, totaling 2882 patients. The ciNPWT group showed a 42% reduction in wound dehiscence (OR 0.58, 95% CI 0.42–0.79; p = 0.0007), with moderate heterogeneity (I² = 36%). No significant differences were found for surgical site infections (OR 0.77, 95% CI 0.50–1.18; p = 0.23) and seroma formation (OR 0.66, 95% CI 0.38–1.12; p = 0.15). Variations in length of stay data prevented quantitative analysis.

Conclusion

ciNPWT demonstrates a significant reduction in wound dehiscence, highlighting its value in enhancing postoperative care, especially for high-risk patients. However, further research involving larger, multicenter randomized controlled trials is necessary to fully elucidate ciNPWT's role in reducing other complications and its broader clinical applicability.