Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty

Robert D. Galiano, MD; Donald Hudson, FRCS, FCS (SA), MMed; Joseph Shin, MD; René van der Hulst, MD, PhD; Volkan Tanaydin, MD; Risal Djohan, MD; Franck Duteille, MD; John Cockwill, MS, CCRP; Sarah Megginson, MSc; Elizabeth Huddleston, PhD

doi:10.1097/GOX.0000000000001560

Plastic and Reconstructive Surgery, Global Open (Jan 2018)

Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty

Robert D. Galiano, MD,
Donald Hudson, FRCS, FCS (SA), MMed,
Joseph Shin, MD,
René van der Hulst, MD, PhD,
Volkan Tanaydin, MD,
Risal Djohan, MD,
Franck Duteille, MD,
John Cockwill, MS, CCRP,
Sarah Megginson, MSc,
Elizabeth Huddleston, PhD

Affiliations

Robert D. Galiano, MD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Donald Hudson, FRCS, FCS (SA), MMed: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Joseph Shin, MD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
René van der Hulst, MD, PhD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Volkan Tanaydin, MD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Risal Djohan, MD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Franck Duteille, MD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
John Cockwill, MS, CCRP: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Sarah Megginson, MSc: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.
Elizabeth Huddleston, PhD: From the *Feinberg School of Medicine, Chicago, Ill.; †University of Cape Town, Cape Town, South Africa; ‡Montefiore Medical Center, New York, N.Y.; §Maastricht University Medical Centre, Maastricht, The Netherlands; ¶Cleveland Clinic, Cleveland, Ohio; ‖University of Nantes, Nantes, France; **Smith & Nephew Wound Management, Inc., Fort Worth, Tex.; and ††Smith & Nephew Wound Management Ltd, Hull, United Kingdom.

DOI: https://doi.org/10.1097/GOX.0000000000001560
Journal volume & issue: Vol. 6, no. 1
p. e1560

Abstract

Read online

Background:. It has been proposed that negative pressure wound therapy (NPWT) applied prophylactically to a closed incision may decrease the incidence of wound complications. Patients undergoing reduction mammaplasty are at risk of wound complications such as delayed healing, infection, and dehiscence, and the bilateral nature of the surgery allows for a within-patient randomized study to evaluate incisional NPWT’s effect in reducing healing complications. Methods:. In this multicenter trial, 200 patients undergoing bilateral reduction mammaplasty were treated with PICO Single-Use NPWT System or standard wound-care dressings randomized to right or left breast for up to 14 days to enable within-patient comparison. Follow-up assessments were conducted to evaluate the difference in incision healing complications up to 21 days postsurgery. Healing complications (for the primary endpoint) were defined as delayed healing (incision not 100% closed by 7 days) and occurrence of dehiscence or infection within 21 days. Individual healing complications were assessed separately as secondary endpoints. Results:. Significantly fewer healing complications (primary endpoint) were noted in NPWT-treated breasts [113 (56.8%)] versus standard care [123 (61.8%)]. The difference of 10 (5.0%) patients with fewer healing complications using NPWT was statistically significant (P = 0.004). NPWT also resulted in a significantly lower incidence of dehiscence (secondary endpoint) compared with standard care [32 patients (16.2%) versus 52 patients (26.4%)] by day 21, a relative reduction of 38% (P < 0.001). Conclusions:. This is the first major prospective, within-patient, randomized, controlled, multicenter study to provide evidence for an incisional NPWT strategy to reduce healing complications.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

About the journal