Prophylactic Negative Pressure Wound Therapy for Closed Abdominal Donor Site Incisions in Autologous Breast Reconstruction: Systematic Review and Meta-analysis

BACKGROUND: Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing wound complications in many types of surgical procedures.^1-4 Its application allows for exudate management and tension offloading from the wound edges.^5 As a result, it may reduce wound complications at the donor site in autologous breast reconstruction (AR). The purpose of this systematic review and meta-analysis is to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in AR. METHODS: This systematic review was reported according to PRISMA guidelines. PubMed and EMBASE were searched in January 2023 to identify all studies which compared the efficacy of ciNPWT to conventional dressings on abdominal donor site complications in autologous reconstruction. There were no restrictions on the date range inquiry. Included studies were published from 2020 to 2022. Data collected included: rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay. RESULTS: A total of 202 articles were screened and eight studies (1,009 patients) met the inclusion criteria. ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33-0.85; p=0.0085, I^2=0%). There was no significant difference in the rate of total wound complications (OR, 0.63; 95% confidence interval, 0.35-1.14; p=0.12, I^2=69%), donor site infection (OR, 0.91; 95% confidence interval, 0.42-1.50; p=0.47, I^2=13%), seroma (OR, 0.74; 95% confidence interval, 0.22-2.49; p=0.63, I^2=57%), or length of hospital stay (SMD, 0.089; 95% confidence interval, -0.13-0.35; p=0.37). CONCLUSIONS: The prophylactic use of ciNPWT on the abdominal donor site for AR is associated with decreased rates of wound dehiscence compared to conventional dressings. No significant difference was detected in rates of total wound complications, infection, seroma, and length of hospital stay. References: 1. Xie W, Dai L, Qi Y, Jiang X. Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta-analysis. Int Wound J. 2022;19(6):1319-1328. doi:10.1111/IWJ.13726 2. Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy for closed laparotomy incisions after ventral hernia repair: A systematic review and meta-analysis. Int J Surg. 2022;97. doi:10.1016/J.IJSU.2021.106216 3. Boll G, Callas P, Bertges DJ. Meta-analysis of prophylactic closed-incision negative pressure wound therapy for vascular surgery groin wounds. J Vasc Surg. 2022;75(6):2086-2093.e9. doi:10.1016/J.JVS.2021.12.070 4. Sahebally SM, McKevitt K, Stephens I, et al. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(11). doi:10.1001/JAMASURG.2018.3467 5. Lalezari S, Lee CJ, Borovikova AA, et al. Deconstructing negative pressure wound therapy. Int Wound J. 2017;14(4):649-657. doi:10.1111/IWJ.12658