The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial

• Published in: Journal of tissue viability Vol. 27; no. 4; pp. 262 - 266
• Main Authors: Muller-Sloof, E., de Laat, H.E.W., Hummelink, S.L.M., Peters, J.W.B., Ulrich, D.J.O.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-11-2018
• Subjects: Adult; Female; Humans; Incidence; Middle Aged; Negative pressure therapy; Negative-Pressure Wound Therapy - methods; Negative-Pressure Wound Therapy - standards; Nursing; Pilot Projects; Postoperative Complications - therapy; Postoperative treatment; Prospective Studies; Reconstructive Surgical Procedures - methods; Reconstructive Surgical Procedures - standards; Risk Factors; Single-Blind Method; Surgical Flaps - standards; Surgical Flaps - surgery; Surgical Wound Dehiscence - therapy; Surgical Wound Infection - surgery; Surgical Wound Infection - therapy; Surgical wounds; Wound dehiscence; Wound rupture; Wound dehiscence; Surgical wounds; Wound rupture; Negative pressure therapy; Postoperative treatment
• ISSN: 0965-206X
• DOI: 10.1016/j.jtv.2018.08.005

Wound dehiscence is a serious postoperative complication associated both with high morbidity and mortality. It has a significant rate of occurrence in breast reconstruction surgeries with a deep internal epigastric perforator (DIEP) and with a profunda artery perforator (PAP) flap. Risk factors for wound dehiscence include smoking, diabetes mellitus, chronic obstructive pulmonary disease, and obesity. The aim of this pilot study was to assess whether postoperative treatment with closed incision negative pressure therapy (ciNPT) decreases the incidence of donor site wound dehiscence in breast reconstruction patients.
Women undergoing a breast reconstruction with a DIEP or PAP flap were enrolled in a pilot randomized controlled trial and assigned treatment with either ciNPT or adhesive strips. The primary outcome was wound dehiscence upon follow-up after four weeks. Secondary outcomes that were evaluated included wound infection, pain, and allergy. There was no loss to follow-up.
This pilot study included 51 women (n = 25 ciNPT, n = 26 adhesive strips). The two groups did not differ significantly in patients demographics or comorbidities. Wound dehiscence occurred in 11 patients (n = 2 ciNPT, n = 9 adhesive strips). This difference was statistically significant: p = 0.038. There were no statistically significant differences in secondary outcomes between the two groups.
In this pilot study, postoperative treatment with ciNPT decreased the incidence of donor site wound dehiscence in breast reconstruction patients. Further research is ongoing by the same hospital.
This trial was registered in the Netherlands Trial Register (NTR) under ID no. NTR5808.
•Autologous breast reconstruction surgery with a deep internal epigastric perforator (DIEP) flap or a profunda artery perforator (PAP) flap are at risk of wound dehiscence.•The donor site related incidence of wound dehiscence differed statistically significant between the two groups.•Closed incision Negative Pressure Therapy reduced the incidence of postoperative wound dehiscence in breast reconstruction patients