The Efficacy of Closed Incision Negative Pressure Therapy in Complex Abdominal Reconstruction in High-Risk Patients
Bao Ngoc N. Tran1; Anna Rose Johnson, MD2; Changyu Shen, PhD2; Edward S. Lee, MD1; Bernard T. Lee, MD, MBA, MPH2
1Division of Plastic & Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, 2Division of Plastic & Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
PURPOSE: Obesity is a known risk factor for donor wound complications in abdominal based microsurgical breast reconstruction. Closed incision negative pressure therapy (ciNPT) has been used anecdotally in high-risk patients to prevent wound complications and infection. Due to the shortage of ciNPT studies in plastic surgery literature, we conducted a systematic review to evaluate the efficacy of this device in reducing wound complications and infection in complex abdominal reconstruction cases and its applicability in abdominal based microsurgical breast reconstruction.
METHODS: A literature search of the English literature in the PubMed/MEDLINE database (2006-2016) was conducted to find publications comparing ciNPT to standard incisional care for complex abdominal wall reconstruction. Outcomes of interest included surgical site infection, wound dehiscence, seroma, hematoma, reoperation, and readmission as overall rates and associations were pooled. A fixed effects model was used to assess between-study heterogeneity and effect size. Funnel plots were used to assess publication bias.
RESULTS: There were 11 studies meeting inclusion criteria with 1723 patients total, 681 in the ciNPT group and 1042 in the standard incisional care. The majority of patients were obese, diabetic, and with recent history of smoking. Funnel plot revealed the majority of incidences reported in the studies were similar to the average, showing no publication bias. The use of ciNPT resulted in lower rate of surgical site infection (15% vs. 28%, RR 0.51, p=0.006, CI 0.39-0.68), wound dehiscence (8% vs. 15%, RR=0.53, p=0.154, CI 0.35-0.80), seroma (6% vs. 8%, RR=0.78,p=0.329, CI 0.48-1.27), hematoma (2% vs. 3%, RR=0.62,p=0.62, CI 0.23-1.64), and readmission (9% vs. 14%, RR=0.53,p=0.285, CI 0.35-0.80). There were only 2 studies reporting reoperation rate so meta-analysis was not performed.
CONCLUSION: The use of ciNPT reduced wound complications in complex abdominal reconstruction in high-risk patients. Similar patient selection can be applied to patients undergoing abdominal based breast reconstruction for future prospective randomized clinical trial to determine the efficacy of ciNPT in plastic surgery.
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