The use of closed incision negative pressure therapy for incision and surrounding soft tissue management: Expert panel consensus recommendations.

As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become available. To expand upon previous ciNPT recommendations and provide guidance on this new dressing, an expert panel of plastic surgeons convened to review the current literature, identify challenges to the implementation and sustainability of ciNPT, and use a modified Delphi technique to form a consensus on the appropriate use of ciNPT with full-coverage dressings. After three rounds of collecting expert opinion via the Delphi method, consensus was reached if 80% of the panel agreed upon a statement. This manuscript establishes 10 consensus statements regarding when ciNPT with full-coverage foam dressings should be considered or recommended in the presence of patient or incision risk factors, effective therapeutic settings and duration, precautions for use, and tools and techniques to support application. The panel also discussed areas of interest for future study of ciNPT with full-coverage dressings. High-quality, controlled studies are needed to expand the understanding of the benefits of ciNPT over the incision and surrounding tissues.

Initial Experience Using Closed Incision Negative Pressure Therapy after Immediate Postmastectomy Breast Reconstruction.

Although immediate postmastectomy breast reconstruction is favored over delayed reconstruction, it remains associated with high complication rates. Potential complications include seroma formation, dehiscence, infection, and tissue necrosis along incision edges. Closed incision negative pressure therapy (ciNPT; Prevena Incision Management System, KCI, an Acelity company, San Antonio, Tex.) has been reported to help hold incision edges together, protect incisions from external contamination, and remove fluid and infectious material. We investigated outcomes of applying ciNPT with a customizable dressing over closed incisions in 13 patients (25 breasts) who received immediate postmastectomy reconstruction as part of 2-stage expander/implant breast reconstruction. Nipple-sparing mastectomy was performed on 14 breasts, reduction-pattern mastectomy on 6 breasts, and skin-sparing mastectomy on 5 breasts. All breasts had ciNPT with a customizable dressing applied over the entire clean closed incision immediately after surgery at -125 mmHg for an average of 4.3 days. At 3-month follow-up, 24 of the 25 (96%) breasts had achieved healing. Delayed hematoma occurred on postoperative day 13 in 1 breast in the nipple-sparing mastectomy group and resolved. In the reduction-pattern mastectomy group, superficial dehiscence occurred on 3 breasts and resolved with local wound care. One breast in that group developed flap necrosis requiring surgical revision. Less drainage was observed in attached closed-suction drains, so time to drain removal was reduced from an estimated average of 12-14 days to 8.2 days. Based on the initial experience in this study, larger studies are warranted to evaluate the use of ciNPT with customizable or peel-and-place dressings after immediate postmastectomy breast reconstruction.