A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

다국어 초록 (Multilingual Abstract)

Background Mastectomy flap necrosis is a common and challenging complication of direct-to-implant (DTI) breast reconstruction. The PICO single-use negative-pressure wound therapy device may reduce the complications associated with skin flap necrosis. We evaluated the relationship between PICO use and the incidence of mild, moderate, and severe skin flap necrosis in patients at high risk of necrosis.
Methods Using medical records from January 2015 to March 2019, we retrospectively analyzed patients who underwent DTI breast reconstruction after oncological breast surgery at a single institution and identified those at high risk for skin flap necrosis. During this period, PICO was used selectively for patients deemed to be at particularly high risk. Patient demographics, operative characteristics, and the degree of skin flap necrosis were compared according to whether PICO was used.
Results Of 117 patients (122 breasts), 45 were deemed to be at high risk of skin flap necrosis. PICO was applied to 38 of these breasts, and seven breasts received a conventional dressing. Skin flap necrosis occurred in 30 breasts (24 in the PICO group [63.2%] vs. 6 in the no-PICO group [85.7%]). Significantly fewer cases of severe skin flap necrosis were observed in the PICO group (2/38 [5.3%]) than in the no-PICO group (3/7 [42.9%]) (P=0.004). There were no significant between-group differences in outcomes measured using BREAST-Q scores.
Conclusions Use of a single-use negative-pressure wound therapy device can reduce the risk of severe skin flap necrosis in patients at high risk of skin flap complications associated with DTI breast reconstruction.

참고문헌 (Reference)

1 Argenta LC, "Vacuum-assisted closure: a new method for wound control and treatment: clinical experience" 38 : 563-576, 1997

2 Gabriel A, "The impact of closed incision negative pressure therapy on postoperative breast reconstruction outcomes" 6 : e1880-, 2018

3 McCarthy CM, "The effect of closed-suction drains on the incidence of local wound complications following tissue expander/implant reconstruction : a cohort study" 119 : 2018-2022, 2007

4 Hultman CS, "Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence, management, and outcome" 50 : 249-255, 2003

5 Matsen CB, "Skin flap necrosis after mastectomy with reconstruction : a prospective study" 23 : 257-264, 2016

6 Chen CF, "Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: a cohort study" 95 : e5605-, 2016

7 Colwell AS, "Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs" 128 : 1170-1178, 2011

8 Suh H, "Negative pressure wound therapy on closed surgical wounds with dead space : animal study using a swine model" 76 : 717-722, 2016

9 Sue GR, "Mastectomy skin necrosis after breast reconstruction : a comparative analysis between autologous reconstruction and implant-based reconstruction" 80 (80): S285-S287, 2018

10 Robertson SA, "Mastectomy skin flap necrosis: challenges and solutions" 9 : 141-152, 2017

11 Huang Y, "Management of severe skin flap necrosis after mastectomy : case report" 2019 : 1184-, 2019

12 Sue GR, "Management of mastectomy skin necrosis in implant based breast reconstruction" 78 (78): S208-S211, 2017

13 Galiano RD, "Incisional negative pressure wound therapy for prevention of wound healing complications following reduction mammaplasty" 6 : e1560-, 2018

14 Spruce P, "Improving outcomes for patients following surgery for breast cancer" 5 : 47-55, 2019

15 Birke-Sorensen H, "Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer): steps towards an international consensus" 64 (64): S1-S16, 2011

16 Kim DY, "Does the use of incisional negativepressure wound therapy prevent mastectomy flap necrosis in immediate expander-based breast reconstruction?" 138 : 558-566, 2016

17 Pusic AL, "Development of a new patientreported outcome measure for breast surgery : the BREAST-Q" 124 : 345-353, 2009

18 Phillips BT, "Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care" 66 : 460-465, 2011

19 Nherera LM, "Cost-effectiveness analysis of single-use negative pressure wound therapy dressings(sNPWT)to reduce surgical site complications(SSC)in routine primary hip and knee replacements" 25 : 474-482, 2017

20 Semsarzadeh NN, "Closed incision negative-pressure therapy is associated with decreased surgical-site infections : a meta-analysis" 136 : 592-602, 2015

21 Ferrando PM, "Closed incision negative pressure therapy in oncological breast surgery : comparison with standard care dressings" 6 : e1732-, 2018

22 Malmsjo M, "Biological effects of a disposable, canisterless negative pressure wound therapy system" 14 : e15-, 2014

23 Payne C, "Application of the single use negative pressure wound therapy device(PICO)on a heterogeneous group of surgical and traumatic wounds" 14 : e20-, 2014

24 Sposato G, "Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable miniVAC device" 54 : 235-237, 2001

25 Rinker B, "A comparison of methods to assess mastectomy flap viability in skin-sparing mastectomy and immediate reconstruction : a prospective cohort study" 137 : 395-401, 2016