Use of Closed Incision Negative Pressure Therapy over Mastectomy Skin Flap Incisions in Patients at Risk for Complications
Previous studies have reported favorable clinical results when using closed incision negative pressure therapy (ciNPT*) over closed incisions following breast reconstruction and other incision types (1,2). In addition, ciNPT may be beneficial when patient-related risk factors or incision/operation-related risk factors are high (1). We describe our initial experience using ciNPT over closed incisions in patients undergoing unilateral or bilateral mastectomies for breast cancer treatment. The effects of ciNPT on 22 closed incisions from 12 patients (mean age: 58 ± 11.5 years) were assessed. Incisions, which were closed with sutures, ranged from 9 cm to 34 cm, and ciNPT was applied at -125 mmHg for 5-7 days. The average number of drains placed per patient was 3.1±1.2, and all patients were prescribed antibiotics to control infection. In addition to breast cancer, other comorbidities included obesity, type 2 diabetes, hypertension, and/or congestive heart failure. Upon removal of ciNPT, 19 of the 22 incisions remained closed; however, one patient experienced dehiscence of an incision resulting from a fall subsequent to ciNPT removal. Two other patients experienced flap failure due to ischemia or vascular compromise, respectively. One flap failure was resolved after surgical debridement, re-closing the wound with sutures, and re-applying ciNPT, whereas the other flap failure required hyperbaric oxygen therapy and serial debridement at a wound care clinic. Another patient experienced an infected seroma three weeks postoperatively, which was resolved after a surgical incision and drainage along with mastectomy flap debridement, closure with sutures, and application of a SOC dressing. At the follow-up visits occurring 1-2 months after surgery, 21 of the 22 incisions were healed, and the remaining incision healed 10 weeks after surgery. The positive outcomes from these cases further support the use of ciNPT over closed breast incisions in patients at risk for complications.